Provider Demographics
NPI:1710909627
Name:KWOK LEUNG CHUNG MD INC
Entity Type:Organization
Organization Name:KWOK LEUNG CHUNG MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KWOK LEUNG
Authorized Official - Middle Name:
Authorized Official - Last Name:CHUNG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-307-0828
Mailing Address - Street 1:600 N GARFIELD AVE
Mailing Address - Street 2:#300
Mailing Address - City:MONTEREY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91754-1166
Mailing Address - Country:US
Mailing Address - Phone:626-307-0828
Mailing Address - Fax:626-307-0980
Practice Address - Street 1:600 N GARFIELD AVE
Practice Address - Street 2:#300
Practice Address - City:MONTEREY PARK
Practice Address - State:CA
Practice Address - Zip Code:91754-1166
Practice Address - Country:US
Practice Address - Phone:626-307-0828
Practice Address - Fax:626-307-0980
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-24
Last Update Date:2015-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG49584207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G495841Medicaid
CA00G495840Medicaid
CA00G495841Medicaid
CAW21861Medicare PIN