Provider Demographics
NPI:1114378171
Name:CHUNG, THOMAS SIN YOUNG (NPF)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:SIN YOUNG
Last Name:CHUNG
Suffix:
Gender:M
Credentials:NPF
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:399 E HIGHLAND AVE
Mailing Address - Street 2:SUITE 307
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92404-3808
Mailing Address - Country:US
Mailing Address - Phone:909-881-7400
Mailing Address - Fax:909-881-5217
Practice Address - Street 1:399 E HIGHLAND AVE
Practice Address - Street 2:SUITE 307
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92404-3808
Practice Address - Country:US
Practice Address - Phone:909-881-7400
Practice Address - Fax:909-881-5217
Is Sole Proprietor?:No
Enumeration Date:2016-06-30
Last Update Date:2016-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95004655363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner