Provider Demographics
NPI:1548318520
Name:CHUNG, HUIJU WINNIE (DO)
Entity type:Individual
Prefix:DR
First Name:HUIJU
Middle Name:WINNIE
Last Name:CHUNG
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:WINNIE
Other - Middle Name:H
Other - Last Name:CHUNG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:3655 LOMITA BLVD
Mailing Address - Street 2:#211
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-3931
Mailing Address - Country:US
Mailing Address - Phone:310-406-3818
Mailing Address - Fax:
Practice Address - Street 1:3655 LOMITA BLVD
Practice Address - Street 2:#211
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-3931
Practice Address - Country:US
Practice Address - Phone:310-406-3818
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2008-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A6809208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00AX68090Medicaid
CA00AX68090Medicaid