Provider Demographics
NPI:1104056845
Name:CHUNG, PETER JEANO (MD)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:JEANO
Last Name:CHUNG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:266 S HARVARD BLVD STE 340
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90004-4372
Mailing Address - Country:US
Mailing Address - Phone:213-908-5014
Mailing Address - Fax:877-778-4959
Practice Address - Street 1:266 S HARVARD BLVD STE 340
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90004-4372
Practice Address - Country:US
Practice Address - Phone:213-908-5014
Practice Address - Fax:877-778-4959
Is Sole Proprietor?:No
Enumeration Date:2009-07-15
Last Update Date:2019-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA121679207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease