Provider Demographics
NPI:1053046060
Name:WENCHE CHUNG, MD & KUOTING LEE, LAC A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:WENCHE CHUNG, MD & KUOTING LEE, LAC A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR.
Authorized Official - Prefix:DR
Authorized Official - First Name:WENCHE
Authorized Official - Middle Name:
Authorized Official - Last Name:CHUNG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-710-8766
Mailing Address - Street 1:2131 HOMET RD
Mailing Address - Street 2:
Mailing Address - City:SAN MARINO
Mailing Address - State:CA
Mailing Address - Zip Code:91108-1325
Mailing Address - Country:US
Mailing Address - Phone:626-464-6800
Mailing Address - Fax:626-226-5858
Practice Address - Street 1:909 S SANTA ANITA AVE STE B
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91006-2363
Practice Address - Country:US
Practice Address - Phone:626-464-6800
Practice Address - Fax:626-226-5858
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-22
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABC3948772OtherDEA