Provider Demographics
NPI:1396874954
Name:HUNG, YUAN LUNG (DMD)
Entity type:Individual
Prefix:
First Name:YUAN LUNG
Middle Name:
Last Name:HUNG
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13768 ROSWELL AVE
Mailing Address - Street 2:#119
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91710-1401
Mailing Address - Country:US
Mailing Address - Phone:909-628-5718
Mailing Address - Fax:
Practice Address - Street 1:13768 ROSWELL AVE
Practice Address - Street 2:#119
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710-1401
Practice Address - Country:US
Practice Address - Phone:909-628-5718
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2009-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48463122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA48463Medicaid
CA48463Medicaid