Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NI0013X | Independent Medical Examiner | DC24102 | CA |
NPI | 1942477229 |
---|---|
Provider Name | Dr. Soungdon Chung |
First Address | Los Angeles, CA 90006-2208 |
Second Address | Los Angeles, CA 90006 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/05/2008 |
Last Update Date | 10/08/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U61538 | (02) | CA |