Healthcare Provider Details

I. General information

NPI: 1801423165
Provider Name (Legal Business Name): DI CHUNG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2020
Last Update Date: 01/19/2024
Certification Date: 01/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 UNION PL
LOS ANGELES CA
90026-5715
US

IV. Provider business mailing address

12291 WASHINGTON BLVD STE 500
WHITTIER CA
90606-2551
US

V. Phone/Fax

Practice location:
  • Phone: 323-644-3880
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A20822
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: