Provider Demographics
NPI:1780008334
Name:CHUNG DENTAL GROUP
Entity Type:Organization
Organization Name:CHUNG DENTAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:CHUNG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:415-823-4005
Mailing Address - Street 1:1765 E BAYSHORE RD
Mailing Address - Street 2:SUITE H
Mailing Address - City:EAST PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94303-2503
Mailing Address - Country:US
Mailing Address - Phone:415-608-1710
Mailing Address - Fax:
Practice Address - Street 1:1765 E BAYSHORE RD
Practice Address - Street 2:SUITE H
Practice Address - City:EAST PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94303-2503
Practice Address - Country:US
Practice Address - Phone:415-608-1710
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-18
Last Update Date:2014-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA54242122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty