Basic Information
| Provider Information | |||||||||
| NPI: | 1659356152 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHAN | ||||||||
| FirstName: | CHUN | ||||||||
| MiddleName: | YU | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DMD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7710 SIGHTSEEING RD BLDG 2826 | ||||||||
| Address2: | US ARMY DENTAL ACTIVITY | ||||||||
| City: | FORT BENNING | ||||||||
| State: | GA | ||||||||
| PostalCode: | 319053764 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7065443103 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 7710 SIGHTSEEING RD BLDG 2826 | ||||||||
| Address2: | US ARMY DENTAL ACTIVITY | ||||||||
| City: | FORT BENNING | ||||||||
| State: | GA | ||||||||
| PostalCode: | 319053764 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7065443103 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/07/2005 | ||||||||
| LastUpdateDate: | 06/23/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | 22DI02232300 | NJ | Y | Dental Providers | Dentist | General Practice |
No ID Information.