Healthcare Provider Details

I. General information

NPI: 1871025809
Provider Name (Legal Business Name): GIGI CHUNG DOCTOR OF PHARMACY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2017
Last Update Date: 03/29/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 EL CAMINO REAL
SOUTH SAN FRANCISCO CA
94080-3208
US

IV. Provider business mailing address

1200 EL CAMINO REAL
SOUTH SAN FRANCISCO CA
94080-3208
US

V. Phone/Fax

Practice location:
  • Phone: 650-742-2627
  • Fax: 650-742-2608
Mailing address:
  • Phone: 650-742-2627
  • Fax: 650-742-2608

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number48755
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: