Provider Demographics
NPI:1255540761
Name:CHUNG, YANG (DDS)
Entity type:Individual
Prefix:DR
First Name:YANG
Middle Name:
Last Name:CHUNG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:PETER
Other - Middle Name:YANG
Other - Last Name:CHUNG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:2246 ROSECRANS AVE
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92833-1742
Mailing Address - Country:US
Mailing Address - Phone:714-870-4111
Mailing Address - Fax:714-870-4055
Practice Address - Street 1:2246 ROSECRANS AVE
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92833-1742
Practice Address - Country:US
Practice Address - Phone:714-870-4111
Practice Address - Fax:714-870-4055
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA312331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice