Provider Demographics
NPI:1326513144
Name:CHUNG, PEI JUNG
Entity type:Individual
Prefix:
First Name:PEI JUNG
Middle Name:
Last Name:CHUNG
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10605 LA RODA DR
Mailing Address - Street 2:
Mailing Address - City:CUPERTINO
Mailing Address - State:CA
Mailing Address - Zip Code:95014-4430
Mailing Address - Country:US
Mailing Address - Phone:408-838-7888
Mailing Address - Fax:
Practice Address - Street 1:15514 MERIDIAN E
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98375-9513
Practice Address - Country:US
Practice Address - Phone:253-268-1215
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-08
Last Update Date:2025-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA102068122300000X
AZD012333122300000X
WADE60740109122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist