Healthcare Provider Details

I. General information

NPI: 1801129234
Provider Name (Legal Business Name): GRACE Y. CHUNG DNP, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: GRACE YEONJOO CHUNG DNP, FNP-BC

II. Dates (important events)

Enumeration Date: 09/17/2009
Last Update Date: 07/13/2023
Certification Date: 01/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 FIVEPOINT
IRVINE CA
92618-2377
US

IV. Provider business mailing address

PO BOX 512185
LOS ANGELES CA
90051-0185
US

V. Phone/Fax

Practice location:
  • Phone: 949-671-4673
  • Fax: 949-671-4329
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number19488
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: