Provider Demographics
NPI:1891218715
Name:CHUNG, YOUNG HO (DDS)
Entity Type:Individual
Prefix:DR
First Name:YOUNG
Middle Name:HO
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 1:477 WINDHARP LN
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93065-7424
Mailing Address - Country:US
Mailing Address - Phone:510-367-1321
Mailing Address - Fax:
Practice Address - Street 1:166 N MOORPARK RD STE 202
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360-4423
Practice Address - Country:US
Practice Address - Phone:805-497-7505
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-23
Last Update Date:2022-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101637122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist