Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YS0123X | Facial Plastic Surgeon | A136426 | CA |
NPI | 1154551042 |
---|---|
Provider Name | Dr. Victor Chung |
First Address | San Diego, CA 92130-6657 |
Second Address | San Diego, CA 92130-6657 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/07/2009 |
Last Update Date | 12/01/2017 |