Provider Demographics
NPI:1740408681
Name:CHUNG, REBECCA (DDS)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:
Last Name:CHUNG
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9095 CENTRAL AVE APT A
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92844-1320
Mailing Address - Country:US
Mailing Address - Phone:951-543-6075
Mailing Address - Fax:
Practice Address - Street 1:9095 CENTRAL AVE APT A
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92844-1320
Practice Address - Country:US
Practice Address - Phone:951-543-6075
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA490811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice