Provider Demographics
NPI:1770614299
Name:CHUNG, BOWEN (MD)
Entity type:Individual
Prefix:DR
First Name:BOWEN
Middle Name:
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 1:1000 WEST CARSON STREET
Mailing Address - Street 2:BOX 498
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90506
Mailing Address - Country:US
Mailing Address - Phone:310-222-1801
Mailing Address - Fax:
Practice Address - Street 1:1000 W CARSON ST # 498
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90502-2004
Practice Address - Country:US
Practice Address - Phone:424-306-5791
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA713242084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry