Provider Demographics
NPI:1760568828
Name:WANG, CHU-JUNE (DMD)
Entity Type:Individual
Prefix:DR
First Name:CHU-JUNE
Middle Name:
Last Name:WANG
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3903 PACIFIC COAST HWY
Mailing Address - Street 2:# D
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-5796
Mailing Address - Country:US
Mailing Address - Phone:310-375-5462
Mailing Address - Fax:310-375-0142
Practice Address - Street 1:3903 PACIFIC COAST HWY
Practice Address - Street 2:# D
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-5796
Practice Address - Country:US
Practice Address - Phone:310-375-5462
Practice Address - Fax:310-375-0142
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA391071223G0001X, 1223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1223G0001XDental ProvidersDentistGeneral Practice
Not Answered1223P0700XDental ProvidersDentistProsthodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB39107-01Medicaid
83816100OtherUNITED CONCORDIA