Provider Demographics
NPI:1306824487
Name:CHUNG, SOOK CLAIRE (MD)
Entity type:Individual
Prefix:DR
First Name:SOOK
Middle Name:CLAIRE
Last Name:CHUNG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SOOKOK
Other - Middle Name:CLAIRE
Other - Last Name:CHUNG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:25825 VERMONT AVE
Mailing Address - Street 2:HARBOR CITY
Mailing Address - City:HARBOR CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90710-3518
Mailing Address - Country:US
Mailing Address - Phone:310-517-2298
Mailing Address - Fax:
Practice Address - Street 1:25825 VERMONT AVE
Practice Address - Street 2:HARBOR CITY
Practice Address - City:HARBOR CITY
Practice Address - State:CA
Practice Address - Zip Code:90710-3518
Practice Address - Country:US
Practice Address - Phone:310-517-2298
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-09
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA98857207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30205368Medicaid
NHRE8411Medicare ID - Type Unspecified
NH30205368Medicaid