MEDICARE: DR. YONG JAE CHUNG D.C.

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	111N00000X	Chiropractor	DC 31391	CA

General Provider Information

NPI Number	:	1982939260
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. YONG JAE CHUNG D.C.

Provider Business Mailing Address
First Line	:	2970 W OLYMPIC BLVD # 303
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90006-2518
Country	:	US
Telephone Number	:	213-388-4030
Fax Number	:	213-388-4034

Provider Business Practice Location Address
First Line	:	2970 W OLYMPIC BLVD # 303
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90006-2518
Country	:	US
Telephone Number	:	213-388-4030
Fax Number	:	213-388-4034

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

Provider Enumeration Date	:	10/05/2009
Last Update Date	:	07/13/2015

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