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General NPI Number Information
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NPI Number | 1356476964
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Entity Type | Individual
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Provider Name | SOON R CHUNG R.PH.
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Gender | Male
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Dates
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Enumeration Date | 02/22/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1400 S GRAND AVE STE 100
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City | LOS ANGELES
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State | CA
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Zip | 90015-3048
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Country | US
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Telephone | 213-746-4215
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Fax | 213-746-4465
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Provider Business Mailing Address
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Address Line | 3534 E LONGRIDGE DR
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City | ORANGE
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State | CA
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Zip | 92867-2021
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Country | US
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Telephone | 714-809-6829
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Fax | 714-998-2141
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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 | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 32816
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License Number State | CA
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