Provider Demographics
NPI:1396037826
Name:SOON R CHUNG
Entity Type:Organization
Organization Name:SOON R CHUNG
Other - Org Name:CAL MED PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:EDDIE
Authorized Official - Middle Name:
Authorized Official - Last Name:CHUNG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-926-0295
Mailing Address - Street 1:1414 S GRAND AVE
Mailing Address - Street 2:STE 101
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90015-3067
Mailing Address - Country:US
Mailing Address - Phone:213-746-4677
Mailing Address - Fax:213-746-8796
Practice Address - Street 1:1414 S GRAND AVE
Practice Address - Street 2:STE 101
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90015-3067
Practice Address - Country:US
Practice Address - Phone:213-746-4677
Practice Address - Fax:213-746-8796
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-02
Last Update Date:2017-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
CA505413336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2130484OtherPK