MEDICARE: CHINATOWN CHRISTIAN MEDICAL GROUP

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	208D00000X	General Practice Physician	FNP 13764	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1538173083
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHINATOWN CHRISTIAN MEDICAL GROUP

Provider Business Mailing Address
First Line	:	711 W COLLEGE ST
Second Line	:	STE 530
City	:	LOS ANGELES
State	:	CA
Zip	:	90012-1163
Country	:	US
Telephone Number	:	213-617-2923
Fax Number	:	213-226-5469

Provider Business Practice Location Address
First Line	:	711 W COLLEGE ST
Second Line	:	STE 530
City	:	LOS ANGELES
State	:	CA
Zip	:	90012-1163
Country	:	US
Telephone Number	:	213-617-2923
Fax Number	:	213-226-5469

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. YIU TING CHUNG
Credential	:	M.D.
Telephone Number	:	213-617-2923

Provider Enumeration Date	:	07/28/2006
Last Update Date	:	08/22/2020

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Directions to “CHINATOWN CHRISTIAN MEDICAL GROUP ” Practice Location

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