| Soomchungmdoncology-hematologypc | |
|
12555 Garden Grove Blvd Ste 309 Garden Grove CA 92843-1903 | |
| (714) 539-6414 | |
| (714) 539-6933 |
| Full Name | Soomchungmdoncology-hematologypc |
|---|---|
| Speciality | Internal Medicine |
| Location | 12555 Garden Grove Blvd Ste 309, Garden Grove, California |
| Authorized Official Name and Position | Soo Marn Chung (CEO) |
| Authorized Official Contact | 7145396414 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Soomchungmdoncology-hematologypc 12555 Garden Grove Blvd Ste 309 Garden Grove CA 92843-1903 Ph: (714) 539-6414 | Soomchungmdoncology-hematologypc 12555 Garden Grove Blvd Ste 309 Garden Grove CA 92843-1903 Ph: (714) 539-6414 |
| NPI Number | 1386812394 |
|---|---|
| Provider Enumeration Date | 02/12/2008 |
| Last Update Date | 02/12/2008 |
| Medicare PECOS PAC ID | 6406933860 |
|---|---|
| Medicare Enrollment ID | O20080409000394 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1386812394 | NPI | - | NPPES |
| 00A410900 | Medicaid | CA | |
| 05D0675453 | Other | CA | CLIA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | A41090 (California) | Secondary |
| 207RH0003X | Internal Medicine - Hematology & Oncology | A41090 (California) | Primary |
| Provider Name | Soo M Chung |
|---|---|
| Provider Type | Practitioner - Hematology/oncology |
| Provider Identifiers | NPI Number: 1245293729 PECOS PAC ID: 6507943966 Enrollment ID: I20080409000388 |
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