Provider Demographics
NPI:1760848311
Name:GRACE H CHUNG, PLLC
Entity type:Organization
Organization Name:GRACE H CHUNG, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:GRACE
Authorized Official - Middle Name:
Authorized Official - Last Name:CHUNG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:702-444-7771
Mailing Address - Street 1:680 S GREEN VALLEY PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-0438
Mailing Address - Country:US
Mailing Address - Phone:702-444-7771
Mailing Address - Fax:702-444-7934
Practice Address - Street 1:680 S GREEN VALLEY PKWY STE 100
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-0438
Practice Address - Country:US
Practice Address - Phone:702-444-7771
Practice Address - Fax:702-444-7934
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-13
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QD0000X
NV6572261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
1295139905OtherNPI TYPE 1
1003265091OtherNPI TYPE 1