MEDICARE: DR. PETER J. CHUNG M.D.

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	208000000X	Pediatrics Physician	A108088	CA
2	390200000X	Student in an Organized Health Care Education/Training Program
3	2080P0006X	Developmental - Behavioral Pediatrics Physician	A108088	CA

General Provider Information

NPI Number	:	1083813687
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PETER J. CHUNG M.D.

Provider Business Mailing Address
First Line	:	2500 REDHILL AVE STE 100
Second Line	:
City	:	SANTA ANA
State	:	CA
Zip	:	92705-5518
Country	:	US
Telephone Number	:	949-267-0400
Fax Number	:	949-221-0004

Provider Business Practice Location Address
First Line	:	2500 REDHILL AVE STE 100
Second Line	:
City	:	SANTA ANA
State	:	CA
Zip	:	92705-5518
Country	:	US
Telephone Number	:	949-267-0400
Fax Number	:	949-221-0004

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/13/2007
Last Update Date	:	07/27/2021

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