Basic Information
| Provider Information | |||||||||
| NPI: | 1841243516 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHUNG | ||||||||
| FirstName: | SANG | ||||||||
| MiddleName: | VAN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3102 E. HIGHLAND AVENUE | ||||||||
| Address2: | MEDICAL STAFF OFFICE | ||||||||
| City: | PATTON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 92369 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9094257679 | ||||||||
| FaxNumber: | 9094256635 | ||||||||
| Practice Location | |||||||||
| Address1: | 3102 E. HIGHLAND AVENUE | ||||||||
| Address2: | MEDICAL STAFF OFFICE | ||||||||
| City: | PATTON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 92369 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9094257679 | ||||||||
| FaxNumber: | 9094256635 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/17/2006 | ||||||||
| LastUpdateDate: | 09/17/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | A413950 | CA | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.