Provider Demographics
NPI:1750352944
Name:CHUNG, CHRISTOPHER K (MD)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:K
Last Name:CHUNG
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 1:21840 NORMANDIE AVE
Mailing Address - Street 2:STE. 200
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90502-2047
Mailing Address - Country:US
Mailing Address - Phone:310-222-3101
Mailing Address - Fax:310-320-6973
Practice Address - Street 1:21840 NORMANDIE AVE
Practice Address - Street 2:STE. 200
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90502-2047
Practice Address - Country:US
Practice Address - Phone:310-222-3101
Practice Address - Fax:310-320-6973
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2009-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA395272084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADA6447OtherRAIL ROAD MEDICARE
CAM050376OtherGROUP PTAN
CAW14940OtherGROUP PTAN
CA00A395270Medicaid
CACH1382OtherRAIL ROAD MEDICARE
CACH1382OtherRAIL ROAD MEDICARE
CA00A395270Medicaid
CAWA39527DMedicare PIN
CAWA39527CMedicare PIN