Doctor Name: | AIMEE CHUNG |
NPI Number: | 1033524509 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | DDS |
License Number: | ETN263 |
Business Practice Address: | 4447 Sepulveda Blvd Culver City, CA - 902304847 |
Business Phone Number: | 3103904444 |
Business Fax Number: | |
Mailing Address: | 6827 Chevy Chase Ave, DALLAS |
State: | TX |
Postal Code: | 752252506 |
Phone Number: | 2148624898 |
Fax Number: | |
NPI Enumeration Date: | 06/24/2014 |
NPI Last Update Date: | 06/23/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 390200000X |
License Number: | ETN263 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | TX |
Taxonomy Type: | Student, Health Care |
Taxonomy Classification: | Student in an Organized Health Care Education/Training Program |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |