Basic Information
| Provider Information | |||||||||
| NPI: | 1609387810 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHUNG | ||||||||
| FirstName: | SUE | ||||||||
| MiddleName: | HYUN | ||||||||
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| Credential: | DDS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4851 KOKOMO DR APT 7523 | ||||||||
| Address2: | |||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958351846 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 3610 W UNIVERSITY DR STE 400 | ||||||||
| Address2: | |||||||||
| City: | MCKINNEY | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750712952 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9725489956 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/14/2017 | ||||||||
| LastUpdateDate: | 08/01/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | 102091 | CA | N | Dental Providers | Dentist | General Practice | 1223G0001X | 35065 | TX | Y | Dental Providers | Dentist | General Practice |
No ID Information.