Provider Demographics
NPI:1154538031
Name:CHUNG, PETER ROBERT (DDS)
Entity type:Individual
Prefix:MR
First Name:PETER
Middle Name:ROBERT
Last Name:CHUNG
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 1:3257 BROWNS VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94558-5424
Mailing Address - Country:US
Mailing Address - Phone:707-257-2800
Mailing Address - Fax:707-257-2218
Practice Address - Street 1:3257 BROWNS VALLEY RD
Practice Address - Street 2:
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94558-5424
Practice Address - Country:US
Practice Address - Phone:707-257-2800
Practice Address - Fax:707-257-2218
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA490821223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice