Provider Demographics
NPI:1922139906
Name:CHE, KI SUNG (MD)
Entity Type:Individual
Prefix:DR
First Name:KI
Middle Name:SUNG
Last Name:CHE
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 1:12506 SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:CERRITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90703-7134
Mailing Address - Country:US
Mailing Address - Phone:562-809-0142
Mailing Address - Fax:
Practice Address - Street 1:12506 SOUTH ST
Practice Address - Street 2:
Practice Address - City:CERRITOS
Practice Address - State:CA
Practice Address - Zip Code:90703-7134
Practice Address - Country:US
Practice Address - Phone:562-809-0142
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2011-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA054222207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG04294Medicare UPIN
CAA54222Medicare ID - Type Unspecified