Provider Demographics
NPI:1952673196
Name:JULIET TAN CHUA, D.M.D., INC.
Entity Type:Organization
Organization Name:JULIET TAN CHUA, D.M.D., INC.
Other - Org Name:ANAHEIM JC DENTAL ARTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JULIET
Authorized Official - Middle Name:TAN
Authorized Official - Last Name:CHUA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:714-399-3668
Mailing Address - Street 1:705 S STATE COLLEGE BLVD
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92806-4527
Mailing Address - Country:US
Mailing Address - Phone:714-399-3668
Mailing Address - Fax:714-399-9310
Practice Address - Street 1:705 S STATE COLLEGE BLVD
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92806-4527
Practice Address - Country:US
Practice Address - Phone:714-399-3668
Practice Address - Fax:714-399-9310
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-03
Last Update Date:2012-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA336741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1063431146OtherDENTI-CAL