Provider Demographics
NPI:1477203289
Name:CHESTER TUNG, D.O., A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:CHESTER TUNG, D.O., A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHESTER
Authorized Official - Middle Name:
Authorized Official - Last Name:TUNG
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:240-506-9855
Mailing Address - Street 1:15573 BROOKHURST ST
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92683-7554
Mailing Address - Country:US
Mailing Address - Phone:240-506-9855
Mailing Address - Fax:
Practice Address - Street 1:15573 BROOKHURST ST
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683-7554
Practice Address - Country:US
Practice Address - Phone:714-775-3066
Practice Address - Fax:714-531-2915
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-25
Last Update Date:2022-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty