MEDICARE: SOON R CHUNG

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies
2	3336C0003X	Community/Retail Pharmacy	PHY48764	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0570158	OTHER		NCPDP PROVIDER IDENTIFICATION NUMBER

General Provider Information

NPI Number	:	1003851320
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOON R CHUNG

Provider Business Mailing Address
First Line	:	1045 W REDONDO BEACH BLVD
Second Line	:	SUITE 300
City	:	GARDENA
State	:	CA
Zip	:	90247-4128
Country	:	US
Telephone Number	:	310-515-6570
Fax Number	:	310-515-6549

Provider Business Practice Location Address
First Line	:	1045 W REDONDO BEACH BLVD
Second Line	:	SUITE 300
City	:	GARDENA
State	:	CA
Zip	:	90247-4128
Country	:	US
Telephone Number	:	310-515-6570
Fax Number	:	310-515-6549

Authorized Official
Title or Position	:	OWNER
Name	:	SOON R CHUNG
Credential	:	R.PH
Telephone Number	:	310-515-6570

Provider Enumeration Date	:	06/19/2006
Last Update Date	:	03/07/2023

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Directions to “SOON R CHUNG ” Practice Location

Language	Start Address	Practice Location

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