Healthcare Provider Details

I. General information

NPI: 1942220777
Provider Name (Legal Business Name): PAUL JINKYU CHUNG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 05/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10833 LE CONTE AVE 12-441 MDCC
LOS ANGELES CA
90095-3075
US

IV. Provider business mailing address

5767 W CENTURY BLVD SUITE 400
LOS ANGELES CA
90045-5631
US

V. Phone/Fax

Practice location:
  • Phone: 310-825-9346
  • Fax: 310-206-4855
Mailing address:
  • Phone: 310-825-9346
  • Fax: 310-206-4855

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA63980
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: