Healthcare Provider Details

I. General information

NPI: 1154958791
Provider Name (Legal Business Name): NORMAN CHUNG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2020
Last Update Date: 05/07/2025
Certification Date: 05/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

293 S MAIN ST STE 100
ORANGE CA
92868-3843
US

IV. Provider business mailing address

15112 TUNGWOOD ST
WESTMINSTER CA
92683-6338
US

V. Phone/Fax

Practice location:
  • Phone: 714-352-2911
  • Fax: 657-221-0805
Mailing address:
  • Phone: 714-653-5338
  • Fax: 657-221-0805

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number34622TLG
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: