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General NPI Number Information
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NPI Number | 1922316645
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Entity Type | Organization
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Legal Business Name | C &K MEDICAL GROUP
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Dates
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Enumeration Date | 09/15/2010
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Last Update Date | 09/15/2010
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Provider Practice Location Address
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Address Line | 12610 S WESTERN AVE
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City | LOS ANGELES
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State | CA
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Zip | 90047-5252
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Country | US
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Telephone | 323-757-1853
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Fax | 323-757-1281
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Provider Business Mailing Address
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Address Line | 12610 S WESTERN AVE
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City | LOS ANGELES
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State | CA
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Zip | 90047-5252
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Country | US
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Telephone | 323-757-1853
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Fax | 323-757-1281
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JAE SUNG CHU
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Credential | M.D.
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Telephone | 323-757-1853
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | A46356
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License Number State | CA
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