Provider Demographics
NPI:1114788445
Name:CHUNG, ERLAINE DE LEOZ (FNP-C)
Entity Type:Individual
Prefix:
First Name:ERLAINE
Middle Name:DE LEOZ
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 1:854 E BASELINE RD
Mailing Address - Street 2:
Mailing Address - City:CLAREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:91711-1571
Mailing Address - Country:US
Mailing Address - Phone:310-739-2563
Mailing Address - Fax:
Practice Address - Street 1:854 E BASELINE RD
Practice Address - Street 2:
Practice Address - City:CLAREMONT
Practice Address - State:CA
Practice Address - Zip Code:91711-1571
Practice Address - Country:US
Practice Address - Phone:310-739-2563
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-23
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95028162207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine