Provider Demographics
NPI:1801051776
Name:CHUNG, ALEXANDER YONG-KWON (DDS)
Entity type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:YONG-KWON
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 1:215 N STATE COLLEGE BLVD STE J
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92806-2995
Mailing Address - Country:US
Mailing Address - Phone:714-333-0770
Mailing Address - Fax:657-208-3373
Practice Address - Street 1:215 N STATE COLLEGE BLVD STE J
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92806-2995
Practice Address - Country:US
Practice Address - Phone:714-333-0770
Practice Address - Fax:657-208-3373
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-21
Last Update Date:2020-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA444661223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics