Basic Information
| Provider Information | |||||||||
| NPI: | 1003152695 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHUNG | ||||||||
| FirstName: | CALEB | ||||||||
| MiddleName: | IAN | ||||||||
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| Credential: | O.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1335 MARTIN LUTHER KING JR WAY | ||||||||
| Address2: | |||||||||
| City: | BERKELEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 947091912 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 100 NEWPARK MALL | ||||||||
| Address2: | |||||||||
| City: | NEWARK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945605252 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5107459030 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/31/2012 | ||||||||
| LastUpdateDate: | 01/03/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 14448TLG | CA | Y | Eye and Vision Services Providers | Optometrist |
No ID Information.