Provider Demographics
NPI:1043304470
Name:CHUNG, JOHN (PA)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:
Last Name:CHUNG
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9700 DE SOTO AVE
Mailing Address - Street 2:
Mailing Address - City:CHATSWORTH
Mailing Address - State:CA
Mailing Address - Zip Code:91311-4409
Mailing Address - Country:US
Mailing Address - Phone:818-882-8100
Mailing Address - Fax:818-700-8255
Practice Address - Street 1:9700 DE SOTO AVE
Practice Address - Street 2:
Practice Address - City:CHATSWORTH
Practice Address - State:CA
Practice Address - Zip Code:91311-4409
Practice Address - Country:US
Practice Address - Phone:818-882-8100
Practice Address - Fax:818-700-8255
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2015-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14523363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical