Provider Demographics
NPI:1861800997
Name:MARK A. CHUNG, O.D., A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:MARK A. CHUNG, O.D., A PROFESSIONAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER, PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:CHUNG
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:323-650-0337
Mailing Address - Street 1:8205 SANTA MONICA BLVD
Mailing Address - Street 2:SUITE 15
Mailing Address - City:WEST HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90046-5977
Mailing Address - Country:US
Mailing Address - Phone:323-650-0337
Mailing Address - Fax:323-650-7783
Practice Address - Street 1:8205 SANTA MONICA BLVD
Practice Address - Street 2:SUITE 15
Practice Address - City:WEST HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90046-5977
Practice Address - Country:US
Practice Address - Phone:323-650-0337
Practice Address - Fax:323-650-7783
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-01
Last Update Date:2014-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty