Provider Demographics
NPI:1194163154
Name:JOE, CONNIE CHUNG (JD)
Entity type:Individual
Prefix:MS
First Name:CONNIE
Middle Name:CHUNG
Last Name:JOE
Suffix:
Gender:F
Credentials:JD
Other - Prefix:MS
Other - First Name:CONNIE
Other - Middle Name:
Other - Last Name:CHUNG JOE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:JD
Mailing Address - Street 1:3727 W 6TH ST STE 320
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90020-5108
Mailing Address - Country:US
Mailing Address - Phone:213-389-6755
Mailing Address - Fax:213-389-5172
Practice Address - Street 1:3727 W 6TH ST STE 320
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90020-5108
Practice Address - Country:US
Practice Address - Phone:213-389-6755
Practice Address - Fax:213-389-5172
Is Sole Proprietor?:No
Enumeration Date:2013-06-11
Last Update Date:2013-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker