Healthcare Provider Details

I. General information

NPI: 1992847065
Provider Name (Legal Business Name): CHRISTOPHER YOUNGKWON CHUNG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2007
Last Update Date: 11/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2815 S MAIN ST SUITE #110
CORONA CA
92882-2531
US

IV. Provider business mailing address

2815 S MAIN ST SUITE #110
CORONA CA
92882-2531
US

V. Phone/Fax

Practice location:
  • Phone: 951-278-8385
  • Fax: 951-278-2930
Mailing address:
  • Phone: 951-278-8385
  • Fax: 951-278-2930

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberA 55450
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: