Provider Demographics
NPI:1689772659
Name:LUNG, GREGORY YAT CHO (DMD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:YAT CHO
Last Name:LUNG
Suffix:
Gender:M
Credentials:DMD
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Other - Credentials:
Mailing Address - Street 1:1580 MAKALOA ST
Mailing Address - Street 2:SUITE #725
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814-3237
Mailing Address - Country:US
Mailing Address - Phone:808-973-3747
Mailing Address - Fax:808-973-3757
Practice Address - Street 1:1580 MAKALOA ST
Practice Address - Street 2:SUITE #725
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-3237
Practice Address - Country:US
Practice Address - Phone:808-973-3747
Practice Address - Fax:808-973-3757
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2008-04-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
HI17291223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIH50880OtherMEDICARE LEGACY