Basic Information
| Provider Information | |||||||||
| NPI: | 1881922912 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHUNG | ||||||||
| FirstName: | KRISTY | ||||||||
| MiddleName: | NAROM | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | N.P. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12291 WASHINGTON BLVD | ||||||||
| Address2: | SUITE 500 | ||||||||
| City: | WHITTIER | ||||||||
| State: | CA | ||||||||
| PostalCode: | 906062500 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5626982541 | ||||||||
| FaxNumber: | 5627894339 | ||||||||
| Practice Location | |||||||||
| Address1: | 12291 WASHINGTON BLVD | ||||||||
| Address2: | SUITE 500 | ||||||||
| City: | WHITTIER | ||||||||
| State: | CA | ||||||||
| PostalCode: | 906062500 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5626982541 | ||||||||
| FaxNumber: | 5627894339 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/01/2009 | ||||||||
| LastUpdateDate: | 11/22/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2200X | 19274 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health | 363LX0106X | 19274 | CA | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Occupational Health |
No ID Information.