Healthcare Provider Details

I. General information

NPI: 1477203289
Provider Name (Legal Business Name): CHESTER TUNG, D.O., A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/25/2022
Last Update Date: 05/04/2022
Certification Date: 05/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15573 BROOKHURST ST
WESTMINSTER CA
92683-7554
US

IV. Provider business mailing address

15573 BROOKHURST ST
WESTMINSTER CA
92683-7554
US

V. Phone/Fax

Practice location:
  • Phone: 714-775-3066
  • Fax: 714-531-2915
Mailing address:
  • Phone: 240-506-9855
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. CHESTER TUNG
Title or Position: PHYSICIAN/PRESIDENT
Credential: DO
Phone: 240-506-9855