Provider Demographics
NPI:1548887318
Name:ALEXANDER YONG-KWON CHUNG DENTAL CORPORATION
Entity type:Organization
Organization Name:ALEXANDER YONG-KWON CHUNG DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:YONG-KWON
Authorized Official - Last Name:CHUNG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:714-366-1974
Mailing Address - Street 1:215 N STATE COLLEGE BLVD STE J
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92806-2995
Mailing Address - Country:US
Mailing Address - Phone:714-333-0770
Mailing Address - Fax:657-208-3373
Practice Address - Street 1:215 N STATE COLLEGE BLVD STE J
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92806-2995
Practice Address - Country:US
Practice Address - Phone:714-333-0770
Practice Address - Fax:657-208-3373
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-28
Last Update Date:2020-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0700XDental ProvidersDentistProsthodonticsGroup - Single Specialty