MEDICARE: CHUNG MEDICAL CORPORATION, INC

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	261QR1300X	Rural Health Clinic/Center	RHM53835G	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1649217431
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHUNG MEDICAL CORPORATION, INC

Provider Business Mailing Address
First Line	:	8401 CALIFORNIA CITY BLVD
Second Line	:	SUITE 7
City	:	CALIFORNIA CITY
State	:	CA
Zip	:	93505-5277
Country	:	US
Telephone Number	:	760-373-1150
Fax Number	:	760-373-7841

Provider Business Practice Location Address
First Line	:	8401 CALIFORNIA CITY BLVD
Second Line	:	SUITE 7
City	:	CALIFORNIA CITY
State	:	CA
Zip	:	93505-5277
Country	:	US
Telephone Number	:	760-373-1150
Fax Number	:	760-373-7841

Authorized Official
Title or Position	:	OWNER / ADMINISTRATOR
Name	:	BEVERLY ELAINE THORBUS
Credential	:	R.N.
Telephone Number	:	760-382-3505

Provider Enumeration Date	:	06/01/2006
Last Update Date	:	11/11/2008

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