Provider Demographics
NPI:1497011308
Name:BENJAMIN CHUNG MD INC
Entity Type:Organization
Organization Name:BENJAMIN CHUNG MD INC
Other - Org Name:RIVERWALK SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER / MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:D
Authorized Official - Last Name:CHUNG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:951-321-0100
Mailing Address - Street 1:4244 RIVERWALK PKWY
Mailing Address - Street 2:SUITE 210
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92505-8509
Mailing Address - Country:US
Mailing Address - Phone:951-321-0100
Mailing Address - Fax:951-321-0131
Practice Address - Street 1:4244 RIVERWALK PKWY
Practice Address - Street 2:SUITE 200
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92505-3372
Practice Address - Country:US
Practice Address - Phone:951-321-0100
Practice Address - Fax:951-321-0131
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-04
Last Update Date:2013-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical