Provider Demographics
NPI:1811036007
Name:CHUNG, MONA LAI KING (MD)
Entity Type:Individual
Prefix:
First Name:MONA
Middle Name:LAI KING
Last Name:CHUNG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:MONA
Other - Middle Name:CHUNG
Other - Last Name:SIU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1509 WILSON TERRACE
Mailing Address - Street 2:GLENDALE ADVENTIST MEDICAL CENTER
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91206-4007
Mailing Address - Country:US
Mailing Address - Phone:818-590-0889
Mailing Address - Fax:
Practice Address - Street 1:1509 WILSON TERRACE
Practice Address - Street 2:GLENDALE ADVENTIST MEDICAL CENTER
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91206-4007
Practice Address - Country:US
Practice Address - Phone:818-409-8247
Practice Address - Fax:818-546-5647
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG308372080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine