Healthcare Provider Details

I. General information

NPI: 1548449622
Provider Name (Legal Business Name): YONG BUM CHUN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2007
Last Update Date: 11/30/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 N RENO ST
LOS ANGELES CA
90026-4656
US

IV. Provider business mailing address

1300 N VERMONT AVE SUITE 1002
LOS ANGELES CA
90027-6098
US

V. Phone/Fax

Practice location:
  • Phone: 213-380-7298
  • Fax: 213-385-1123
Mailing address:
  • Phone: 323-669-4326
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA80401
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: