Healthcare Provider Details

I. General information

NPI: 1013569896
Provider Name (Legal Business Name): CONNIE CHUNG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2019
Last Update Date: 10/25/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1720 E CESAR E CHAVEZ AVE
LOS ANGELES CA
90033-2414
US

IV. Provider business mailing address

1818 MICHIGAN AVE APT 605
LOS ANGELES CA
90033-2458
US

V. Phone/Fax

Practice location:
  • Phone: 323-260-5781
  • Fax:
Mailing address:
  • Phone: 714-422-4446
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: