Provider Demographics
NPI:1992897458
Name:CHUNG, SAMUEL KWOK-KUEN (MD)
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:KWOK-KUEN
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 1:223 N. GARFIELD AVE, SUITE 301
Mailing Address - Street 2:
Mailing Address - City:MONTEREY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91754
Mailing Address - Country:US
Mailing Address - Phone:626-572-3688
Mailing Address - Fax:626-572-2788
Practice Address - Street 1:223 N. GARFIELD AVE, SUITE 301
Practice Address - Street 2:
Practice Address - City:MONTEREY PARK
Practice Address - State:CA
Practice Address - Zip Code:91754
Practice Address - Country:US
Practice Address - Phone:626-572-3688
Practice Address - Fax:626-572-2788
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2024-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA33894208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA33894OtherCA LICENSE
CA00A338940Medicaid