Provider Demographics
NPI:1629148515
Name:CHUNG, KHIN-POH OSCAR (OD)
Entity Type:Individual
Prefix:DR
First Name:KHIN-POH
Middle Name:OSCAR
Last Name:CHUNG
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 ESCONDIDO AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92084-6170
Mailing Address - Country:US
Mailing Address - Phone:760-630-2020
Mailing Address - Fax:760-634-6918
Practice Address - Street 1:217 ESCONDIDO AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92084-6170
Practice Address - Country:US
Practice Address - Phone:760-630-2020
Practice Address - Fax:760-634-6918
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOP6186T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0061861OtherMEDI-CAL
CASD0061860OtherMEDI-CAL
CAY7938Medicare ID - Type Unspecified
CAT87908Medicare UPIN