Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | A-26581 | CA |
NPI | 1205387743 |
---|---|
Provider Name | Dr. Charles Myung |
First Address | Garden Grove, CA 92841-4005 |
Second Address | Garden Grove, CA 92841-4005 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/10/2016 |
Last Update Date | 19/10/2016 |