MEDICARE: DR. EDWARD J. CHUNG MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207P00000X	Emergency Medicine Physician	A85505	CA

General Provider Information

NPI Number	:	1114954989
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EDWARD J. CHUNG MD

Provider Business Mailing Address
First Line	:	2701 OCEAN PARK BLVD
Second Line	:	112
City	:	SANTA MONICA
State	:	CA
Zip	:	90405-5200
Country	:	US
Telephone Number	:	310-314-4260
Fax Number	:	310-314-4298

Provider Business Practice Location Address
First Line	:	4560 ADMIRALTY WAY
Second Line	:	100
City	:	MARINA DEL REY
State	:	CA
Zip	:	90292-5423
Country	:	US
Telephone Number	:	310-827-3700
Fax Number	:	310-578-5379

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/27/2006
Last Update Date	:	07/08/2007

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