Individual
DR. MICHAEL CHUNG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S., M.D.
Contact information
Practice address
360 E LAS TUNAS DR STE 206, SAN GABRIEL, CA 91776-5514
(818) 768-2062
Mailing address
360 E LAS TUNAS DR STE 206, SAN GABRIEL, CA 91776-5514
(818) 780-2062
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
64034
CA
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
64034
CA
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
Primary
64035
CA
Other
Enumeration date
11/20/2015
Last updated
06/25/2020
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