Provider Demographics
NPI:1437106366
Name:CHUNG, JEFFREY MAN-SZE (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:MAN-SZE
Last Name:CHUNG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JEFFREY
Other - Middle Name:MAN-SZE
Other - Last Name:CHUNG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:127 SOUTH SAN VICENTE BLVD.
Mailing Address - Street 2:SUITE A6600
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-1804
Mailing Address - Country:US
Mailing Address - Phone:310-423-6472
Mailing Address - Fax:310-423-0130
Practice Address - Street 1:8700 BEVERLY BLVD
Practice Address - Street 2:ROOM 4127
Practice Address - City:WEST HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90048-1804
Practice Address - Country:US
Practice Address - Phone:310-423-6472
Practice Address - Fax:310-423-0130
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA751492084N0400X
FLME942692084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL273826100Medicaid
FL273826100Medicaid
H81162Medicare UPIN