Provider Demographics
NPI:1841316833
Name:CHUNG, MARK ALLEN (OD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:ALLEN
Last Name:CHUNG
Suffix:
Gender:M
Credentials:OD
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Mailing Address - Street 1:8205 SANTA MONICA BLVD
Mailing Address - Street 2:SUITE 15
Mailing Address - City:WEST HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90046-5967
Mailing Address - Country:US
Mailing Address - Phone:323-650-0337
Mailing Address - Fax:323-650-7783
Practice Address - Street 1:8205 SANTA MONICA BLVD
Practice Address - Street 2:SUITE 15
Practice Address - City:WEST HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90046-5967
Practice Address - Country:US
Practice Address - Phone:323-650-0337
Practice Address - Fax:323-650-7783
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA7904T152W00000X, 152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered152W00000XEye and Vision Services ProvidersOptometrist
Not Answered152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management