Provider Demographics
NPI:1245293729
Name:CHUNG, SOO MARN (MD)
Entity type:Individual
Prefix:DR
First Name:SOO
Middle Name:MARN
Last Name:CHUNG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:18000 STUDEBAKER RD STE 800
Mailing Address - Street 2:
Mailing Address - City:CERRITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90703-2671
Mailing Address - Country:US
Mailing Address - Phone:562-735-3226
Mailing Address - Fax:
Practice Address - Street 1:11480 BROOKSHIRE AVE STE 309
Practice Address - Street 2:
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90241-5025
Practice Address - Country:US
Practice Address - Phone:562-869-1201
Practice Address - Fax:562-869-1281
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-07
Last Update Date:2021-02-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA41090207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A410900Medicaid
CA00A410900Medicaid
CAA29292Medicare UPIN