Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 33974TLG | CA |
NPI | 1003301391 |
---|---|
Provider Name | Allen Chung |
First Address | San Diego, CA 92126-4870 |
Second Address | San Diego, CA 92119 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/06/2018 |
Last Update Date | 15/12/2019 |