Provider Demographics
NPI:1649451196
Name:CHUNG, GRACE YOON MI (DDS)
Entity type:Individual
Prefix:DR
First Name:GRACE
Middle Name:YOON MI
Last Name:CHUNG
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:YOON
Other - Middle Name:MI
Other - Last Name:CHUNG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:27110 EUCALYPTUS AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92555-4542
Mailing Address - Country:US
Mailing Address - Phone:951-616-1759
Mailing Address - Fax:
Practice Address - Street 1:27110 EUCALYPTUS AVE
Practice Address - Street 2:SUITE A
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92555-4542
Practice Address - Country:US
Practice Address - Phone:951-616-1759
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-26
Last Update Date:2012-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA562521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice