Healthcare Provider Details

I. General information

NPI: 1215773544
Provider Name (Legal Business Name): GLORIA CHUNG, D.O., INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2024
Last Update Date: 07/05/2024
Certification Date: 07/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 E HOLT AVE STE G
POMONA CA
91767-5800
US

IV. Provider business mailing address

1101 E HOLT AVE STE G
POMONA CA
91767-5800
US

V. Phone/Fax

Practice location:
  • Phone: 909-632-0895
  • Fax: 909-620-8193
Mailing address:
  • Phone: 909-632-0895
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. GLORIA CHUNG
Title or Position: PRESIDENT
Credential: DO
Phone: 909-632-0895