Provider Demographics
NPI:1285786053
Name:CHUN, MIA (DDS)
Entity type:Individual
Prefix:
First Name:MIA
Middle Name:
Last Name:CHUN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24307 SOUTHLAND DR
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94545-1517
Mailing Address - Country:US
Mailing Address - Phone:510-785-3900
Mailing Address - Fax:510-785-6141
Practice Address - Street 1:24301 SOUTHLAND DR STE 505
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94545-1553
Practice Address - Country:US
Practice Address - Phone:510-785-3900
Practice Address - Fax:510-785-6141
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2017-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA38823122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist