Healthcare Provider Details

I. General information

NPI: 1487566378
Provider Name (Legal Business Name): KATHERINE CHUNG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/17/2026
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8942 GARDEN GROVE BLVD STE 104
GARDEN GROVE CA
92844-3332
US

IV. Provider business mailing address

8942 GARDEN GROVE BLVD STE 104
GARDEN GROVE CA
92844-3332
US

V. Phone/Fax

Practice location:
  • Phone: 714-638-0852
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT36388-TLG
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: