Provider Demographics
NPI:1790759140
Name:MUN, EDWARD C (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:C
Last Name:MUN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:23451 MADISON ST STE 340
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-4762
Mailing Address - Country:US
Mailing Address - Phone:310-373-6864
Mailing Address - Fax:310-373-9547
Practice Address - Street 1:23451 MADISON ST STE 340
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-4762
Practice Address - Country:US
Practice Address - Phone:310-373-6864
Practice Address - Fax:310-373-9547
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2021-12-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG88540208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3143899Medicaid
MA3143899Medicaid
MAA20769Medicare ID - Type Unspecified