Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 14448TLG | CA |
NPI | 1003152695 |
---|---|
Provider Name | Caleb Ian Chung |
First Address | Berkeley, CA 94709-1912 |
Second Address | Newark, CA 94560-5252 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/12/2012 |
Last Update Date | 03/01/2022 |