Provider Demographics
NPI:1083659908
Name:CHUNGSUK MEDICAL GROUP, INC.
Entity Type:Organization
Organization Name:CHUNGSUK MEDICAL GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHUNG
Authorized Official - Middle Name:HEE
Authorized Official - Last Name:SUK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-538-8679
Mailing Address - Street 1:103 AMETHYST CIR
Mailing Address - Street 2:
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90248-3374
Mailing Address - Country:US
Mailing Address - Phone:310-538-8679
Mailing Address - Fax:
Practice Address - Street 1:103 AMETHYST CIR
Practice Address - Street 2:
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90248-3374
Practice Address - Country:US
Practice Address - Phone:310-538-8679
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA53525207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA53525CMedicare ID - Type UnspecifiedINDIVIDUAL PROVIDER NUMBE