=====================================================
General NPI Number Information
=====================================================
NPI Number | 1750575916
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FARFALLA INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/30/2007
-----------------------------------------------------
Last Update Date | 10/25/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3655 LOMITA BLVD #211
-----------------------------------------------------
City | TORRANCE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90505-3931
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-383-5388
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1236 CHELSEA AVE #1
-----------------------------------------------------
City | SANTA MONICA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90404-1461
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-383-5388
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | DR. HUI JU W. CHUNG
-----------------------------------------------------
Credential | D.O.
-----------------------------------------------------
Telephone | 310-383-5388
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2300X
-----------------------------------------------------
Taxonomy Name | Primary Care Clinic/Center
-----------------------------------------------------
License Number | 20A6809
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------