Healthcare Provider Details

I. General information

NPI: 1053060178
Provider Name (Legal Business Name): CHAM JUNG DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2022
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7171 N CEDAR AVE
FRESNO CA
93720-3311
US

IV. Provider business mailing address

2625 E DIVISADERO ST
FRESNO CA
93721-1431
US

V. Phone/Fax

Practice location:
  • Phone: 559-449-8000
  • Fax: 559-443-2682
Mailing address:
  • Phone: 559-443-2682
  • Fax: 559-443-2681

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number20A21866
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: