Justin Tony Chung, D.D.S.
Individual provider Active NPI Dentist · Stanton, CA
NPI 1093905481 · NPPES record last updated Sep 8, 2022
Key facts
- NPI
- 1093905481
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 56138 (CA)
- Practice address
- 12362 Beach Blvd Ste 10
Stanton, CA 90680-3944 - Phone
- (714) 248-9500
- Fax
- (714) 622-4943
- NPI assigned
- Jul 31, 2007
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 56138 | CA | Yes |
Addresses
Primary practice location
12362 Beach Blvd Ste 10
Stanton, CA 90680-3944
Mailing address
12362 Beach Blvd Ste 10
Stanton, CA 90680-3944
Phone (714) 248-9500
Other providers in Stanton, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 8, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.