Provider Demographics
NPI:1801050554
Name:CHUN, BRAD EVAN (DDS)
Entity type:Individual
Prefix:DR
First Name:BRAD
Middle Name:EVAN
Last Name:CHUN
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 1:911 MEDICAL CENTER PLZ
Mailing Address - Street 2:SUITE # 13
Mailing Address - City:WINDSOR
Mailing Address - State:CA
Mailing Address - Zip Code:95492-7815
Mailing Address - Country:US
Mailing Address - Phone:707-838-6697
Mailing Address - Fax:
Practice Address - Street 1:911 MEDICAL CENTER PLZ
Practice Address - Street 2:SUITE # 13
Practice Address - City:WINDSOR
Practice Address - State:CA
Practice Address - Zip Code:95492-7815
Practice Address - Country:US
Practice Address - Phone:707-838-6697
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-11
Last Update Date:2008-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA547241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice