Provider Demographics
NPI:1013253814
Name:CHHEN, CHUNG KOANG (PHARMD)
Entity Type:Individual
Prefix:MR
First Name:CHUNG
Middle Name:KOANG
Last Name:CHHEN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16328 MAGNOLIA WAY
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92336-5694
Mailing Address - Country:US
Mailing Address - Phone:909-427-9320
Mailing Address - Fax:
Practice Address - Street 1:894 OAK VALLEY PKWY
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:CA
Practice Address - Zip Code:92223-1463
Practice Address - Country:US
Practice Address - Phone:951-769-7370
Practice Address - Fax:951-769-0123
Is Sole Proprietor?:No
Enumeration Date:2012-12-25
Last Update Date:2016-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH50228183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist