Provider Demographics
NPI:1881654481
Name:WANG, CHUNG KUN (DDS)
Entity Type:Individual
Prefix:
First Name:CHUNG KUN
Middle Name:
Last Name:WANG
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 1:1580 VALENCIA STREET,
Mailing Address - Street 2:SUITE 605
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94110-4415
Mailing Address - Country:US
Mailing Address - Phone:415-648-5100
Mailing Address - Fax:415-648-9035
Practice Address - Street 1:1580 VALENCIA ST
Practice Address - Street 2:SUITE 605
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94110-4423
Practice Address - Country:US
Practice Address - Phone:415-648-5100
Practice Address - Fax:415-648-9035
Is Sole Proprietor?:No
Enumeration Date:2006-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA386191223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry