Dr. Michael Chung, D.D.S., M.D.
Oral & Maxillofacial Surgery in San Gabriel, CA. Individual provider (NPI-1).
NPI number1154795656
StatusActive
Last updated in NPPESJun 25, 2020
Details
- NPI
- 1154795656
- Entity type
- Individual (NPI-1)
- Name
- Dr. Michael Chung
- Credential
- D.D.S., M.D.
- Sex
- Male
- Sole proprietor
- Yes
- Enumeration date
- Nov 20, 2015
- Certification date
- Jun 25, 2020
- Last updated
- Jun 25, 2020
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 204E00000X | Oral & Maxillofacial Surgery | 64035 | CA | Yes |
| 122300000X | Dentist | 64034 | CA | |
| 1223S0112X | Dentist, Oral and Maxillofacial Surgery | 64034 | CA |
Practice location
360 E Las Tunas Dr Ste 206San Gabriel, CA 91776-5514
Phone 818-768-2062
Mailing address
360 E Las Tunas Dr Ste 206San Gabriel, CA 91776-5514
Phone 818-780-2062
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