Provider Demographics
NPI:1841746799
Name:CHUNG, BEAU MICHAEL (DO)
Entity Type:Individual
Prefix:
First Name:BEAU
Middle Name:MICHAEL
Last Name:CHUNG
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3220 S BREA CANYON RD
Mailing Address - Street 2:STE H
Mailing Address - City:DIAMOND BAR
Mailing Address - State:CA
Mailing Address - Zip Code:91765-3481
Mailing Address - Country:US
Mailing Address - Phone:909-594-1848
Mailing Address - Fax:909-594-5969
Practice Address - Street 1:3220 S BREA CANYON RD
Practice Address - Street 2:SUITE H
Practice Address - City:DIAMOND BAR
Practice Address - State:CA
Practice Address - Zip Code:91765-3481
Practice Address - Country:US
Practice Address - Phone:909-594-1848
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-31
Last Update Date:2019-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A14922208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice