Healthcare Provider Details

I. General information

NPI: 1497011308
Provider Name (Legal Business Name): BENJAMIN CHUNG MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2012
Last Update Date: 04/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4244 RIVERWALK PKWY SUITE 200
RIVERSIDE CA
92505-3372
US

IV. Provider business mailing address

4244 RIVERWALK PKWY SUITE 210
RIVERSIDE CA
92505-8509
US

V. Phone/Fax

Practice location:
  • Phone: 951-321-0100
  • Fax: 951-321-0131
Mailing address:
  • Phone: 951-321-0100
  • Fax: 951-321-0131

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. BENJAMIN D CHUNG
Title or Position: OWNER / MEDICAL DIRECTOR
Credential: M.D.
Phone: 951-321-0100