Provider Demographics
NPI:1861642860
Name:CHUNG, KWANG SOON (DDS)
Entity Type:Individual
Prefix:
First Name:KWANG
Middle Name:SOON
Last Name:CHUNG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9804 RANCHO VERDE DR
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93311-3007
Mailing Address - Country:US
Mailing Address - Phone:661-665-8519
Mailing Address - Fax:
Practice Address - Street 1:9804 RANCHO VERDE DR
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93311-3007
Practice Address - Country:US
Practice Address - Phone:661-665-8519
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-25
Last Update Date:2008-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA30742122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist