Healthcare Provider Details

I. General information

NPI: 1063772663
Provider Name (Legal Business Name): CHRISTINE CHUNG M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2012
Last Update Date: 03/22/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 S GRAND AVE
LOS ANGELES CA
90015-3010
US

IV. Provider business mailing address

1012 CALLE CONTENTO
GLENDALE CA
91208-3017
US

V. Phone/Fax

Practice location:
  • Phone: 818-391-8500
  • Fax:
Mailing address:
  • Phone: 818-391-8500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number127513
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: