MEDICARE: DR. JENIFER CHUNGAFUNG MD

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	207Q00000X	Family Medicine Physician	G060485	CA

General Provider Information

NPI Number	:	1376684985
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JENIFER CHUNGAFUNG MD

Provider Business Mailing Address
First Line	:	1850 S AZUSA AVE
Second Line	:	#60
City	:	HACIENDA HTS
State	:	CA
Zip	:	91745-6813
Country	:	US
Telephone Number	:	626-913-2822
Fax Number	:	626-913-0661

Provider Business Practice Location Address
First Line	:	1850 S AZUSA AVE
Second Line	:	#60
City	:	HACIENDA HTS
State	:	CA
Zip	:	91745-6813
Country	:	US
Telephone Number	:	626-913-2822
Fax Number	:	626-913-0661

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

Provider Enumeration Date	:	02/08/2007
Last Update Date	:	07/08/2007

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