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General NPI Number Information
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NPI Number | 1720232416
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Entity Type | Individual
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Provider Name | CHUNG HEE SUK MD
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Gender | Female
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Dates
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Enumeration Date | 11/08/2008
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Last Update Date | 11/08/2008
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Provider Practice Location Address
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Address Line | 15435 S WESTERN AVE 201
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City | GARDENA
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State | CA
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Zip | 90249-4323
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Country | US
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Telephone | 310-844-8679
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Fax | 310-515-9874
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Provider Business Mailing Address
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Address Line | 15435 S WESTERN AVE 201
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City | GARDENA
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State | CA
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Zip | 90249-4323
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Country | US
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Telephone | 310-515-9871
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Fax | 310-515-9874
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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 | 261QC1500X
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Taxonomy Name | Community Health Clinic/Center
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License Number | A53525
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License Number State | CA
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