Provider Demographics
NPI:1275577447
Name:CHUNG, NANCY MARIE (MD)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:MARIE
Last Name:CHUNG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:NANCY
Other - Middle Name:MARIE
Other - Last Name:WELCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2815 S MAIN ST STE 110
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92882-2532
Mailing Address - Country:US
Mailing Address - Phone:951-278-8385
Mailing Address - Fax:951-278-2930
Practice Address - Street 1:2815 S MAIN ST STE 110
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92882-2532
Practice Address - Country:US
Practice Address - Phone:951-278-8385
Practice Address - Fax:951-278-2930
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-16
Last Update Date:2012-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA76750207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH99732Medicare UPIN