=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821568478
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ALLEN TAE CHUNG PHARMD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/27/2018
-----------------------------------------------------
Last Update Date | 11/27/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13331 MOORPARK ST APT 333
-----------------------------------------------------
City | SHERMAN OAKS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91423
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 949-735-8358
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 13331 MOORPARK ST APT 333
-----------------------------------------------------
City | SHERMAN OAKS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91423
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 949-735-8358
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number | 79970
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------