Provider Demographics
NPI:1912630542
Name:ELAINE CHUNG OD INC
Entity Type:Organization
Organization Name:ELAINE CHUNG OD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ELAINE
Authorized Official - Middle Name:
Authorized Official - Last Name:CHUNG
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:408-502-7636
Mailing Address - Street 1:690 RIVER OAKS PKWY STE 20
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95134-3226
Mailing Address - Country:US
Mailing Address - Phone:408-502-7636
Mailing Address - Fax:408-502-7635
Practice Address - Street 1:690 RIVER OAKS PKWY STE 20
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95134-3226
Practice Address - Country:US
Practice Address - Phone:408-502-7636
Practice Address - Fax:408-502-7635
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-01
Last Update Date:2022-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty