Provider Demographics
NPI:1033865704
Name:CHUNG, MARY ANN M (FNP-C)
Entity Type:Individual
Prefix:
First Name:MARY ANN
Middle Name:M
Last Name:CHUNG
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 S CHEVY CHASE DR STE 250
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91205-4433
Mailing Address - Country:US
Mailing Address - Phone:818-265-2264
Mailing Address - Fax:
Practice Address - Street 1:801 S CHEVY CHASE DR STE 250
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91205-4433
Practice Address - Country:US
Practice Address - Phone:818-265-2264
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-22
Last Update Date:2022-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95019761363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily