Provider Demographics
NPI:1568841120
Name:CHUNG, MAX
Entity Type:Individual
Prefix:
First Name:MAX
Middle Name:
Last Name:CHUNG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2560 W OLYMPIC BLVD STE 201
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90006-2998
Mailing Address - Country:US
Mailing Address - Phone:213-386-7575
Mailing Address - Fax:213-386-7576
Practice Address - Street 1:2560 W OLYMPIC BLVD STE 201
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90006-2998
Practice Address - Country:US
Practice Address - Phone:213-386-7575
Practice Address - Fax:213-386-7576
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-28
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16442171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist