Doctor Name: | JAII CHUNG |
NPI Number: | 1104181130 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | 783250 |
Business Practice Address: | 5720 Imperial Hwy Suitew N-o South Gate, CA - 902807518 |
Business Phone Number: | 5622503100 |
Business Fax Number: | 3237761499 |
Mailing Address: | 5720 Imperial Hwy, Suitew N-o SOUTH GATE |
State: | CA |
Postal Code: | 902807518 |
Phone Number: | 5622503100 |
Fax Number: | 3237761499 |
NPI Enumeration Date: | 07/05/2012 |
NPI Last Update Date: | 07/05/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 364SC1501X |
License Number: | 783250 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CA |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Clinical Nurse Specialist |
Taxonomy Specialization: | Community Health/Public Health |
Taxonomy Definition: |