Provider Demographics
NPI:1336161777
Name:CHUNG, RICHARD S (DDS)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:S
Last Name:CHUNG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:RICHARD
Other - Middle Name:S
Other - Last Name:CHUNG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:5512 E BRITTON DR STE 206
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90815-3150
Mailing Address - Country:US
Mailing Address - Phone:562-430-5259
Mailing Address - Fax:562-430-6309
Practice Address - Street 1:5512 E BRITTON DR STE 206
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90815-3150
Practice Address - Country:US
Practice Address - Phone:562-430-5259
Practice Address - Fax:562-430-6309
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA444671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice