1285667972 NPI number — DR. KRISTY CHUNG D.M.D.

Table of content: DR. KRISTY CHUNG D.M.D. (NPI 1285667972)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285667972 NPI number — DR. KRISTY CHUNG D.M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHUNG
Provider First Name:
KRISTY
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CHUNG
Provider Other First Name:
KYUNG
Provider Other Middle Name:
WON
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1285667972
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/21/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
860 E. REMINGTON DR. SUITE A
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SUNNYVALE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94087
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
408-675-1700
Provider Business Mailing Address Fax Number:
408-542-9797

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
860 E. REMINGTON DR. SUITE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SUNNYVALE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94087
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
408-675-1700
Provider Business Practice Location Address Fax Number:
408-542-9797
Provider Enumeration Date:
07/08/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223X0400X , with the licence number:  20693 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1223X0400X , with the licence number: 51563 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0204358 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".