Provider Demographics
NPI:1396713228
Name:CHUA CHING, BRENDALYN ONG (DMD)
Entity type:Individual
Prefix:DR
First Name:BRENDALYN
Middle Name:ONG
Last Name:CHUA CHING
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:805 W IMPERIAL HWY
Mailing Address - Street 2:
Mailing Address - City:BREA
Mailing Address - State:CA
Mailing Address - Zip Code:92821-3807
Mailing Address - Country:US
Mailing Address - Phone:714-255-0168
Mailing Address - Fax:714-255-0169
Practice Address - Street 1:805 W IMPERIAL HWY
Practice Address - Street 2:
Practice Address - City:BREA
Practice Address - State:CA
Practice Address - Zip Code:92821-3807
Practice Address - Country:US
Practice Address - Phone:714-255-0168
Practice Address - Fax:714-255-0169
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA407981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice