Provider Demographics
NPI:1194086835
Name:CHUNG, VAN HAI (MS)
Entity type:Individual
Prefix:MS
First Name:VAN
Middle Name:HAI
Last Name:CHUNG
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8148 GENESEE AVE APT 139
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92122-1462
Mailing Address - Country:US
Mailing Address - Phone:808-728-2150
Mailing Address - Fax:
Practice Address - Street 1:8148 GENESEE AVE APT 139
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92122-1462
Practice Address - Country:US
Practice Address - Phone:808-728-2150
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-30
Last Update Date:2012-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist