Provider Demographics
NPI:1881625135
Name:CHUNG, YONG D (M,D,)
Entity type:Individual
Prefix:
First Name:YONG
Middle Name:D
Last Name:CHUNG
Suffix:
Gender:M
Credentials:M,D,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1750
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93539-1750
Mailing Address - Country:US
Mailing Address - Phone:661-942-0101
Mailing Address - Fax:661-723-5031
Practice Address - Street 1:43830 10TH ST W
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-4826
Practice Address - Country:US
Practice Address - Phone:661-940-1346
Practice Address - Fax:661-940-1362
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2016-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA35722174400000X, 207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A357220OtherBS CA
CAP00323488OtherRR MEDICARE
CA00A357220Medicaid
CAA84803Medicare UPIN
CA00A357220OtherBS CA