Provider Demographics
NPI:1164729927
Name:CHIA JEN CHUNG, MD, INC.
Entity Type:Organization
Organization Name:CHIA JEN CHUNG, MD, INC.
Other - Org Name:LAUREL HEIGHTS PLASTIC SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PLASTIC SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:CHIA
Authorized Official - Middle Name:JEN
Authorized Official - Last Name:CHUNG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:415-771-7710
Mailing Address - Street 1:390 LAUREL ST STE 205
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94118-1953
Mailing Address - Country:US
Mailing Address - Phone:415-771-7710
Mailing Address - Fax:415-771-7707
Practice Address - Street 1:390 LAUREL ST STE 205
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94118-1953
Practice Address - Country:US
Practice Address - Phone:415-771-7710
Practice Address - Fax:415-771-7707
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-14
Last Update Date:2011-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA91498208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty