Provider Demographics
NPI:1588114201
Name:CHUNG, THOMAS G JR (DDS)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:G
Last Name:CHUNG
Suffix:JR
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 1:972 LUPIN DR STE B
Mailing Address - Street 2:
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93906-3980
Mailing Address - Country:US
Mailing Address - Phone:831-422-6461
Mailing Address - Fax:
Practice Address - Street 1:972 LUPIN DR STE B
Practice Address - Street 2:
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93906-3980
Practice Address - Country:US
Practice Address - Phone:831-422-6461
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-05
Last Update Date:2016-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13781122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist