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General NPI Number Information
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NPI Number | 1194425165
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Entity Type | Individual
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Provider Name | CLAIRE JU-EUN CHONG
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Gender | Female
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Dates
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Enumeration Date | 03/07/2023
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Last Update Date | 08/14/2024
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Provider Practice Location Address
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Address Line | 4425 S CENTRAL AVE
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City | LOS ANGELES
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State | CA
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Zip | 90011-3629
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Country | US
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Telephone | 323-908-3200
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Fax |
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Provider Business Mailing Address
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Address Line | 727 S ARDMORE AVE APT 704
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City | LOS ANGELES
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State | CA
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Zip | 90005-4368
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Country | US
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Telephone | 714-616-1700
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 62450
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License Number State | CA
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