Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086X0206X | Surgical Oncologist | A78889 | CA |
NPI | 1326296542 |
---|---|
Provider Name | Alice Chung |
First Address | Santa Monica, CA 90404-2032 |
Second Address | Santa Monica, CA 90404-2032 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/08/2008 |
Last Update Date | 29/08/2008 |