Provider Demographics
NPI:1932418464
Name:CHUN, FREDERICK (DMD)
Entity Type:Individual
Prefix:
First Name:FREDERICK
Middle Name:
Last Name:CHUN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1947 BELLA OAKS DR
Mailing Address - Street 2:
Mailing Address - City:TULARE
Mailing Address - State:CA
Mailing Address - Zip Code:93274-6274
Mailing Address - Country:US
Mailing Address - Phone:818-282-6018
Mailing Address - Fax:
Practice Address - Street 1:1979 HILLMAN ST
Practice Address - Street 2:
Practice Address - City:TULARE
Practice Address - State:CA
Practice Address - Zip Code:93274-1601
Practice Address - Country:US
Practice Address - Phone:559-732-4279
Practice Address - Fax:559-636-4455
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-01
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA59416122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist