Provider Demographics
NPI:1578272563
Name:CHUNG, NARI Y
Entity Type:Individual
Prefix:
First Name:NARI
Middle Name:Y
Last Name:CHUNG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16919 S DALTON AVE APT 101
Mailing Address - Street 2:
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90247-5454
Mailing Address - Country:US
Mailing Address - Phone:323-793-1544
Mailing Address - Fax:
Practice Address - Street 1:16919 S DALTON AVE APT 101
Practice Address - Street 2:
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90247-5454
Practice Address - Country:US
Practice Address - Phone:323-793-1544
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-17
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95021751363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner