Provider Demographics
NPI:1760490627
Name:CHUNG, KWOK LEUNG (MD)
Entity Type:Individual
Prefix:
First Name:KWOK LEUNG
Middle Name:
Last Name:CHUNG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2015-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG49584207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G495840Medicaid
CA00G495841Medicaid
CA00G495841Medicaid
CAW21861Medicare PIN