Healthcare Provider Details

I. General information

NPI: 1477908523
Provider Name (Legal Business Name): PCHUNG CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2016
Last Update Date: 09/30/2021
Certification Date: 09/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4333 ADMIRALTY WAY STE 9
MARINA DEL REY CA
90292-5469
US

IV. Provider business mailing address

4333 ADMIRALTY WAY STE 9
MARINA DEL REY CA
90292-5469
US

V. Phone/Fax

Practice location:
  • Phone: 310-944-6985
  • Fax: 310-953-9800
Mailing address:
  • Phone: 310-751-0514
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number550002019
License Number StateCA

VIII. Authorized Official

Name: MR. PAUL Y CHUNG
Title or Position: PRESIDENT
Credential:
Phone: 310-944-6985