Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 152W00000X | Optometrist | 14542TLG | CA |
N | 152W00000X | Optometrist | 1976 | AZ |
Y | 152W00000X | Optometrist | 2907 | CO |
NPI | 1003194507 |
---|---|
Provider Name | Dr. Kenneth Chung |
First Address | Westminster, CO 80023-9127 |
Second Address | Westminster, CO 80023-9174 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/08/2011 |
Last Update Date | 20/11/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
042856 | (05) | CO |