Provider Demographics
NPI:1114954989
Name:CHUNG, EDWARD J (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:J
Last Name:CHUNG
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Gender:M
Credentials:MD
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Mailing Address - Street 1:2701 OCEAN PARK BLVD
Mailing Address - Street 2:112
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90405-5200
Mailing Address - Country:US
Mailing Address - Phone:310-314-4260
Mailing Address - Fax:310-314-4298
Practice Address - Street 1:4560 ADMIRALTY WAY
Practice Address - Street 2:100
Practice Address - City:MARINA DEL REY
Practice Address - State:CA
Practice Address - Zip Code:90292-5423
Practice Address - Country:US
Practice Address - Phone:310-827-3700
Practice Address - Fax:310-578-5379
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
CAA85505207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine