Provider Demographics
NPI:1891184917
Name:CHUNG, GUYEON
Entity Type:Individual
Prefix:
First Name:GUYEON
Middle Name:
Last Name:CHUNG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12627 SANTA GERTRUDES AVE
Mailing Address - Street 2:STE E
Mailing Address - City:LA MIRADA
Mailing Address - State:CA
Mailing Address - Zip Code:90638-2533
Mailing Address - Country:US
Mailing Address - Phone:562-902-6033
Mailing Address - Fax:562-902-6092
Practice Address - Street 1:3551 W OLYMPIC BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90019-3504
Practice Address - Country:US
Practice Address - Phone:323-737-2000
Practice Address - Fax:323-731-5342
Is Sole Proprietor?:No
Enumeration Date:2015-01-13
Last Update Date:2020-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program