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General NPI Number Information
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NPI Number | 1629554605
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Entity Type | Individual
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Provider Name | GRACE CHUNG
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Gender | Female
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Dates
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Enumeration Date | 07/12/2018
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Last Update Date | 09/13/2019
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Provider Practice Location Address
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Address Line | 2130 E 4TH ST STE 200
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City | SANTA ANA
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State | CA
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Zip | 92705-3818
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Country | US
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Telephone | 714-543-5437
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Fax |
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Provider Business Mailing Address
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Address Line | 333 S BEAUDRY AVE
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City | LOS ANGELES
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State | CA
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Zip | 90017-1466
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Country | US
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Telephone | 213-241-3841
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Fax | 213-241-3305
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | ASW89592
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License Number State | CA
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