MEDICARE: SUNNY S CHAE

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	3336C0003X	Community/Retail Pharmacy
2	333600000X	Pharmacy	PHY43802	CA

General Provider Information

NPI Number	:	1609016294
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUNNY S CHAE

Provider Business Mailing Address
First Line	:	3919 BEVERLY BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90004-3432
Country	:	US
Telephone Number	:	323-665-5939
Fax Number	:	323-665-8601

Provider Business Practice Location Address
First Line	:	3919 BEVERLY BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90004-3432
Country	:	US
Telephone Number	:	323-665-5939
Fax Number	:	323-665-8601

Authorized Official
Title or Position	:	OWNER/PHARMACIST-IN-CHARGE
Name	:	SUNNY S CHAE
Credential	:	RPH
Telephone Number	:	323-665-5939

Provider Enumeration Date	:	02/23/2009
Last Update Date	:	02/23/2009

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