Basic Information
Provider Information
NPI: 1205820586
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CHUNG
FirstName: CATHERINE
MiddleName: B
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 210 N TUSTIN AVE
Address2:  
City: SANTA ANA
State: CA
PostalCode: 927053807
CountryCode: US
TelephoneNumber: 7143471010
FaxNumber: 7146471245
Practice Location
Address1: 1001 N TUSTIN AVE
Address2:  
City: SANTA ANA
State: CA
PostalCode: 927053502
CountryCode: US
TelephoneNumber: 7149533515
FaxNumber: 7149534259
Other Information
ProviderEnumerationDate: 09/01/2005
LastUpdateDate: 05/25/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207L00000XG77777CAY Allopathic & Osteopathic PhysiciansAnesthesiology 

No ID Information.


Home