Healthcare Provider Details

I. General information

NPI: 1588024723
Provider Name (Legal Business Name): ANN YAHAN CHUNG NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: YAHAN CHUNG NP-C

II. Dates (important events)

Enumeration Date: 03/01/2016
Last Update Date: 12/13/2022
Certification Date: 12/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 N GARFIELD AVE STE 304
MONTEREY PARK CA
91754-1242
US

IV. Provider business mailing address

PO BOX 31309
LOS ANGELES CA
90031-0309
US

V. Phone/Fax

Practice location:
  • Phone: 626-307-6600
  • Fax: 626-656-8076
Mailing address:
  • Phone: 323-442-5100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95004146
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License NumberRN690890
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: