Healthcare Provider Details

I. General information

NPI: 1659835866
Provider Name (Legal Business Name): PATTI CHUNG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/23/2019
Last Update Date: 01/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 MEDICAL PLAZA STE 426
LOS ANGELES CA
90095-0001
US

IV. Provider business mailing address

PO BOX 3706
SOUTH PASADENA CA
91031-6706
US

V. Phone/Fax

Practice location:
  • Phone: 310-794-1458
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number47575
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: