Healthcare Provider Details

I. General information

NPI: 1912111543
Provider Name (Legal Business Name): LINCOLN HEIGHTS FAMILY & INDUSTRIAL MEDICAL CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

437 N EUCLID AVE SUITE A
ONTARIO CA
91762-3456
US

IV. Provider business mailing address

437 N. EUCLID AVE. SUITE A
ONTARIO CA
91762
US

V. Phone/Fax

Practice location:
  • Phone: 909-988-2555
  • Fax: 909-988-4447
Mailing address:
  • Phone: 909-988-2555
  • Fax: 909-988-4447

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A6725
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License NumberA37294
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberA33894
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA 16663
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA 14845
License Number StateCA
# 6
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberRN 548298
License Number State

VIII. Authorized Official

Name: SAMUEL KWOK-KUEN CHUNG
Title or Position: PRESIDENT
Credential: M.D.
Phone: 909-988-2555