| NPI | 1689739476 |
|---|---|
| Former Name | JOHN CHUNG |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: VA 0401008234) |
| Additional Taxonomies | 122300000X Dentist (Licence: VA 8234) |
| Enumeration Date | 2006-12-22 |
| Last Update Date | 2020-01-02 |