Healthcare Provider Details

I. General information

NPI: 1053757955
Provider Name (Legal Business Name): VICTORIA CHUNG M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2013
Last Update Date: 12/23/2021
Certification Date: 12/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4150 V ST SUITE 3500
SACRAMENTO CA
95817-1460
US

IV. Provider business mailing address

4150 V ST SUITE 3500
SACRAMENTO CA
95817-1460
US

V. Phone/Fax

Practice location:
  • Phone: 916-734-3014
  • Fax: 916-734-7920
Mailing address:
  • Phone: 916-734-3014
  • Fax: 916-734-7920

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA125693
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberA125693
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: