Provider Demographics
NPI:1336489277
Name:CHUNG, ANNA S (PHD)
Entity Type:Individual
Prefix:PROF
First Name:ANNA
Middle Name:S
Last Name:CHUNG
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:ANNA
Other - Middle Name:S
Other - Last Name:LAU
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:BOX 951563 UCLA PSYCHOLOGY DEPARTMENT
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES,
Mailing Address - State:CA
Mailing Address - Zip Code:90095-1563
Mailing Address - Country:US
Mailing Address - Phone:310-206-5363
Mailing Address - Fax:
Practice Address - Street 1:UCLA PSYCHOLOGY DEPARTMENT
Practice Address - Street 2:502 PORTOLA PLAZA
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90095-0001
Practice Address - Country:US
Practice Address - Phone:310-206-5363
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-28
Last Update Date:2013-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY20192103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical