Provider Demographics
NPI:1386681187
Name:CHUNG MEDICAL CORPORATION, INC
Entity Type:Organization
Organization Name:CHUNG MEDICAL CORPORATION, INC
Other - Org Name:BEVERLY MEDICAL CENTER, II, INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER / ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:BEVERLY
Authorized Official - Middle Name:ELAINE
Authorized Official - Last Name:THORBUS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:760-382-3505
Mailing Address - Street 1:1415 W ROSAMOND BLVD
Mailing Address - Street 2:SUITE 24
Mailing Address - City:ROSAMOND
Mailing Address - State:CA
Mailing Address - Zip Code:93560-7429
Mailing Address - Country:US
Mailing Address - Phone:661-256-1866
Mailing Address - Fax:661-256-1649
Practice Address - Street 1:1415 W ROSAMOND BLVD
Practice Address - Street 2:SUITE 24
Practice Address - City:ROSAMOND
Practice Address - State:CA
Practice Address - Zip Code:93560-7429
Practice Address - Country:US
Practice Address - Phone:661-256-1866
Practice Address - Fax:661-256-1649
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-01
Last Update Date:2008-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARHM53857G261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARHM53857GMedicaid
CAHAP53857GMedicaid
CA553857Medicare Oscar/Certification