Healthcare Provider Details

I. General information

NPI: 1437142981
Provider Name (Legal Business Name): SOON R. CHUNG
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2005
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 S GRAND AVE #100
LOS ANGELES CA
90015-3048
US

IV. Provider business mailing address

1400 S GRAND AVE #100
LOS ANGELES CA
90015-3048
US

V. Phone/Fax

Practice location:
  • Phone: 213-746-4114
  • Fax: 213-746-4465
Mailing address:
  • Phone: 213-746-4114
  • Fax: 213-746-4465

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberPHY46585
License Number StateCA

VIII. Authorized Official

Name: MR. SOON R CHUNG
Title or Position: OWNER
Credential: R.PH
Phone: 213-746-4114