Healthcare Provider Details

I. General information

NPI: 1417375627
Provider Name (Legal Business Name): ALFRED CHUNG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2014
Last Update Date: 03/03/2021
Certification Date: 03/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 PARNASSUS AVE FL 4
SAN FRANCISCO CA
94143-2202
US

IV. Provider business mailing address

400 PARNASSUS AVE
SAN FRANCISCO CA
94143-2202
US

V. Phone/Fax

Practice location:
  • Phone: 415-353-2421
  • Fax:
Mailing address:
  • Phone: 650-723-6661
  • Fax: 650-498-6205

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0000X
TaxonomyHematology (Internal Medicine) Physician
License NumberA137526
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: