Provider Demographics
NPI:1154529279
Name:CHON, KYUNG R (DDS)
Entity type:Individual
Prefix:
First Name:KYUNG
Middle Name:R
Last Name:CHON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 S VERMONT AVE
Mailing Address - Street 2:SUITE 109
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90006
Mailing Address - Country:US
Mailing Address - Phone:213-384-9800
Mailing Address - Fax:213-384-3884
Practice Address - Street 1:1001 S VERMONT AVE
Practice Address - Street 2:SUITE 109
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90006
Practice Address - Country:US
Practice Address - Phone:213-384-9800
Practice Address - Fax:213-384-3884
Is Sole Proprietor?:No
Enumeration Date:2007-07-10
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32282122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB32282 01Medicaid