Provider Demographics
NPI:1730307562
Name:LOUIE, EDISON CHUNG (DDS INC)
Entity Type:Individual
Prefix:DR
First Name:EDISON
Middle Name:CHUNG
Last Name:LOUIE
Suffix:
Gender:M
Credentials:DDS INC
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:500 S ANAHEIM HILLS RD
Mailing Address - Street 2:STE. 220
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92807-4780
Mailing Address - Country:US
Mailing Address - Phone:714-998-5710
Mailing Address - Fax:714-998-3532
Practice Address - Street 1:500 S ANAHEIM HILLS RD
Practice Address - Street 2:STE. 220
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92807-4780
Practice Address - Country:US
Practice Address - Phone:714-998-5710
Practice Address - Fax:714-998-3532
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA221631223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice