Provider Demographics
NPI:1134362205
Name:CHUNG, GLORIA HA PHUOC (DO)
Entity type:Individual
Prefix:
First Name:GLORIA HA
Middle Name:PHUOC
Last Name:CHUNG
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 E HOLT AVE
Mailing Address - Street 2:SUITE G
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91767-5800
Mailing Address - Country:US
Mailing Address - Phone:909-632-0895
Mailing Address - Fax:
Practice Address - Street 1:1101 E HOLT AVE
Practice Address - Street 2:SUITE G
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91767-5800
Practice Address - Country:US
Practice Address - Phone:909-632-0895
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-19
Last Update Date:2024-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A11437208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics