Basic Information
| Provider Information | |||||||||
| NPI: | 1891184917 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHUNG | ||||||||
| FirstName: | GUYEON | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12627 SANTA GERTRUDES AVE | ||||||||
| Address2: | STE E | ||||||||
| City: | LA MIRADA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 906382533 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5629026033 | ||||||||
| FaxNumber: | 5629026092 | ||||||||
| Practice Location | |||||||||
| Address1: | 3551 W OLYMPIC BLVD | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900193504 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3237372000 | ||||||||
| FaxNumber: | 3237315342 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/13/2015 | ||||||||
| LastUpdateDate: | 09/11/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/11/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | CA | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.