Gabriella Chung, DMD
Individual provider Active NPI Dentist · Paso Robles, CA
NPI 1508542507 · NPPES record last updated Aug 2, 2023
Key facts
- NPI
- 1508542507
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- PENDING (CA)
- Practice address
- 1171 Creston Rd Ste 107
Paso Robles, CA 93446-3031 - Phone
- (805) 202-4988
- NPI assigned
- Jun 23, 2023
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PENDING | CA | MD | Dentist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | PENDING | CA | Yes |
Addresses
Primary practice location
1171 Creston Rd Ste 107
Paso Robles, CA 93446-3031
Mailing address
7700 Denrock Ave
Los Angeles, CA 90045-1163
Phone (424) 288-6729
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 109038 | Other | CA | DENTAL LICENSE |
Other providers in Paso Robles, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 2, 2023. 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.