Provider Demographics
NPI:1174173488
Name:JOHN W. CHUNG D.D.S., INC.
Entity type:Organization
Organization Name:JOHN W. CHUNG D.D.S., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:W
Authorized Official - Last Name:CHUNG
Authorized Official - Suffix:II
Authorized Official - Credentials:DDA
Authorized Official - Phone:805-487-4903
Mailing Address - Street 1:905 W 7TH ST
Mailing Address - Street 2:
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93030-6755
Mailing Address - Country:US
Mailing Address - Phone:805-487-4903
Mailing Address - Fax:805-487-0009
Practice Address - Street 1:905 W 7TH ST
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93030-6755
Practice Address - Country:US
Practice Address - Phone:805-487-4903
Practice Address - Fax:805-487-0009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-18
Last Update Date:2019-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental