Provider Demographics
NPI:1316261738
Name:CHUNG, ELEANOR L (MD)
Entity type:Individual
Prefix:DR
First Name:ELEANOR
Middle Name:L
Last Name:CHUNG
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:1001 POTRERO AVE
Mailing Address - Street 2:CHILDREN'S HEALTH CENTER, 6M
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94110-3518
Mailing Address - Country:US
Mailing Address - Phone:415-719-2636
Mailing Address - Fax:415-206-5721
Practice Address - Street 1:1001 POTRERO AVE
Practice Address - Street 2:CHILDREN'S HEALTH CENTER, 6M
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94110-3518
Practice Address - Country:US
Practice Address - Phone:415-719-2636
Practice Address - Fax:415-206-5721
Is Sole Proprietor?:No
Enumeration Date:2010-03-15
Last Update Date:2012-12-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA110964208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA022091391Medicare UPIN