Basic Information
| Provider Information | |||||||||
| NPI: | 1003021882 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHUNG | ||||||||
| FirstName: | REX | ||||||||
| MiddleName: | TONG HYUN | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 25246 BARTON RD | ||||||||
| Address2: | APT. #12 | ||||||||
| City: | LOMA LINDA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 923543060 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9092108222 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 11175 CAMPUS ST | ||||||||
| Address2: | RM 21008 | ||||||||
| City: | LOMA LINDA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 923501700 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9095588131 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/14/2007 | ||||||||
| LastUpdateDate: | 03/23/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | A99992 | CA | N | Allopathic & Osteopathic Physicians | Surgery | 2086S0102X | A99992 | CA | Y | Allopathic & Osteopathic Physicians | Surgery | Surgical Critical Care |
No ID Information.