Provider Demographics
NPI:1659144640
Name:NOLAN R UNG MD INC
Entity Type:Organization
Organization Name:NOLAN R UNG MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/MD
Authorized Official - Prefix:DR
Authorized Official - First Name:NOLAN
Authorized Official - Middle Name:R
Authorized Official - Last Name:UNG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-936-2631
Mailing Address - Street 1:2371 GRAND AVE UNIT 90093
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90809-6003
Mailing Address - Country:US
Mailing Address - Phone:909-936-2631
Mailing Address - Fax:949-502-8887
Practice Address - Street 1:727 WEST RD
Practice Address - Street 2:
Practice Address - City:LA HABRA HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:90631-8055
Practice Address - Country:US
Practice Address - Phone:909-936-2631
Practice Address - Fax:949-502-8887
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-01
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health