Healthcare Provider Details

I. General information

NPI: 1851944821
Provider Name (Legal Business Name): JOYCE CHUNG MSN, AGACNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2019
Last Update Date: 09/19/2022
Certification Date: 09/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

705 W LA VETA AVE STE 107
ORANGE CA
92868-4447
US

IV. Provider business mailing address

705 W LA VETA AVE STE 107
ORANGE CA
92868-4447
US

V. Phone/Fax

Practice location:
  • Phone: 714-639-4901
  • Fax:
Mailing address:
  • Phone: 714-639-4901
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number95012193
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: