Provider Demographics
NPI:1972778306
Name:CHUKHMAN, ANNA (DDS)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:CHUKHMAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23310 CINEMA DR
Mailing Address - Street 2:SUITE 103
Mailing Address - City:VALENCIA
Mailing Address - State:CA
Mailing Address - Zip Code:91355-1612
Mailing Address - Country:US
Mailing Address - Phone:661-255-6500
Mailing Address - Fax:661-255-3952
Practice Address - Street 1:23310 CINEMA DR
Practice Address - Street 2:SUITE 103
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91355-1612
Practice Address - Country:US
Practice Address - Phone:661-255-6500
Practice Address - Fax:661-255-3952
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-27
Last Update Date:2008-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47361122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist