Provider Demographics
NPI:1194818518
Name:CHUNG, JAMES (OD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:CHUNG
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:JAMES
Other - Middle Name:YICHIN
Other - Last Name:CHUNG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:20442 MILANO CT
Mailing Address - Street 2:
Mailing Address - City:YORBA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92886-8623
Mailing Address - Country:US
Mailing Address - Phone:626-315-7522
Mailing Address - Fax:
Practice Address - Street 1:720 E VALLEY BLVD
Practice Address - Street 2:
Practice Address - City:SAN GABRIEL
Practice Address - State:CA
Practice Address - Zip Code:91776-3547
Practice Address - Country:US
Practice Address - Phone:626-288-8097
Practice Address - Fax:626-288-8031
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-30
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11494T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0114940Medicaid
CASD0114940Medicaid