Provider Demographics
NPI:1740547264
Name:HUR, CHA (DDS)
Entity type:Individual
Prefix:
First Name:CHA
Middle Name:
Last Name:HUR
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:CHA AE GLORIA
Other - Middle Name:
Other - Last Name:HUR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:3320 N LOS COYOTES DIAGONAL STE 200
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90808-3938
Mailing Address - Country:US
Mailing Address - Phone:562-377-1375
Mailing Address - Fax:
Practice Address - Street 1:3320 N LOS COYOTES DIAGONAL STE 200
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90808-3938
Practice Address - Country:US
Practice Address - Phone:562-377-1375
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-22
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA645251223P0221X, 1223P0221X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program