Provider Demographics
NPI:1629568688
Name:CHUNG, SEUNGHWAN (DDS)
Entity type:Individual
Prefix:
First Name:SEUNGHWAN
Middle Name:
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 1:7291 BOULDER AVE STE 2B
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:CA
Mailing Address - Zip Code:92346-6900
Mailing Address - Country:US
Mailing Address - Phone:909-425-8980
Mailing Address - Fax:909-862-6695
Practice Address - Street 1:7291 BOULDER AVE STE 2B
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:CA
Practice Address - Zip Code:92346-6900
Practice Address - Country:US
Practice Address - Phone:909-425-8980
Practice Address - Fax:909-862-6695
Is Sole Proprietor?:No
Enumeration Date:2018-05-15
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53203122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist