Provider Demographics
NPI:1437438884
Name:CHUN, BRYCE C (DDS)
Entity type:Individual
Prefix:DR
First Name:BRYCE
Middle Name:C
Last Name:CHUN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 CALIFORNIA BLVD STE L
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-2545
Mailing Address - Country:US
Mailing Address - Phone:805-545-9400
Mailing Address - Fax:805-545-8336
Practice Address - Street 1:620 CALIFORNIA BLVD STE L
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-2545
Practice Address - Country:US
Practice Address - Phone:805-545-9400
Practice Address - Fax:805-545-8336
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-16
Last Update Date:2024-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA605411223P0300X, 1223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics