Healthcare Provider Details

I. General information

NPI: 1417190596
Provider Name (Legal Business Name): LINDA HANNA CHUNG M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LINDA HANNA LEE M.D.

II. Dates (important events)

Enumeration Date: 04/20/2009
Last Update Date: 03/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

718 UNIVERSITY AVE STE 211
LOS GATOS CA
95032-7608
US

IV. Provider business mailing address

3003 WOODSIDE MEADOWS RD
PLEASANT HILL CA
94523-3187
US

V. Phone/Fax

Practice location:
  • Phone: 408-354-2114
  • Fax: 408-354-0633
Mailing address:
  • Phone: 217-390-3268
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP3000X
TaxonomyPediatric Anesthesiology Physician
License NumberA127592
License Number StateCA
# 2
Primary TaxonomyN
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: