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General NPI Number Information
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NPI Number | 1851721716
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Entity Type | Organization
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Legal Business Name | LILY S. CHUNG, MD, PC
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Dates
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Enumeration Date | 11/13/2013
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Last Update Date | 06/16/2014
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Provider Practice Location Address
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Address Line | 28078 BAXTER RD SUITE 228
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City | MURRIETA
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State | CA
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Zip | 92563-1402
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Country | US
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Telephone | 909-521-8698
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Fax | 909-266-0055
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Provider Business Mailing Address
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Address Line | PO BOX 11509
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City | SAN BERNARDINO
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State | CA
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Zip | 92423-1509
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Country | US
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Telephone | 909-521-8698
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Fax | 909-266-0055
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Authorized Official
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Title or Position | PSYCHIATRIST
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Name | LILY S. CHUNG
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Credential | MD
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Telephone | 909-521-8698
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | A78636
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License Number State | CA
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