Provider Demographics
NPI:1902329402
Name:CHAK, ELIZABETH TING YU (DMD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:TING YU
Last Name:CHAK
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27898 VIOLET
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-6688
Mailing Address - Country:US
Mailing Address - Phone:949-331-2537
Mailing Address - Fax:
Practice Address - Street 1:2407 ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806-3221
Practice Address - Country:US
Practice Address - Phone:562-981-1000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-17
Last Update Date:2021-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS1023781223G0001X
PADS041285122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist