Healthcare Provider Details

I. General information

NPI: 1174079040
Provider Name (Legal Business Name): PETER J. CHUNG, M.D. INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2016
Last Update Date: 08/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

266 S HARVARD BLVD SUITE 340
LOS ANGELES CA
90004-4372
US

IV. Provider business mailing address

266 S HARVARD BLVD SUITE 340
LOS ANGELES CA
90004-4372
US

V. Phone/Fax

Practice location:
  • Phone: 786-877-4558
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA121679
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberA121679
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberA121679
License Number StateCA

VIII. Authorized Official

Name: PETER J CHUNG
Title or Position: PRESIDENT
Credential: M.D.
Phone: 213-908-5014