Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | A100200 | CA |
N | 111NI0900X | Internist | A100200 | CA |
Y | 207RR0500X | Rheumatology | A100200 | CA |
NPI | 1033396767 |
---|---|
Provider Name | Sue Yeon Chung |
First Address | Mission Hills, CA 91346-9602 |
Second Address | Porter Ranch, CA 91326-4141 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/01/2008 |
Last Update Date | 17/05/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A1002000 | (05) | CA |