| NPI | 1184164295 |
|---|---|
| Former Name | TIFFANY CHUNG |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: LA 7591) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 102195) |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: TX 34838) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-03-08 |
| Last Update Date | 2024-07-19 |