Provider Demographics
NPI:1427070242
Name:KUNG, PETER (DDS)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:
Last Name:KUNG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:PETER
Other - Middle Name:CHUNG-YUEN
Other - Last Name:KUNG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:3535 ROSS AVE
Mailing Address - Street 2:STE 201
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95124-3038
Mailing Address - Country:US
Mailing Address - Phone:408-265-8056
Mailing Address - Fax:408-265-5115
Practice Address - Street 1:3535 ROSS AVE
Practice Address - Street 2:STE 201
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95124-3038
Practice Address - Country:US
Practice Address - Phone:408-265-8056
Practice Address - Fax:408-265-5115
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA25080122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist