Healthcare Provider Details

I. General information

NPI: 1952837312
Provider Name (Legal Business Name): HUNG CHUNG, MD, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2017
Last Update Date: 05/04/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14807 HARMONY LN
WESTMINSTER CA
92683-5852
US

IV. Provider business mailing address

14807 HARMONY LN
WESTMINSTER CA
92683-5852
US

V. Phone/Fax

Practice location:
  • Phone: 318-675-5815
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA131729
License Number StateCA

VIII. Authorized Official

Name: HUNG CHUNG
Title or Position: PRESIDENT
Credential:
Phone: 225-939-2592