Provider Demographics
NPI:1053346940
Name:MUN, DONG W (MD)
Entity type:Individual
Prefix:
First Name:DONG
Middle Name:W
Last Name:MUN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3511 W OLYMPIC BLVD
Mailing Address - Street 2:#101
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90019-3563
Mailing Address - Country:US
Mailing Address - Phone:323-766-1057
Mailing Address - Fax:323-766-8790
Practice Address - Street 1:3511 W OLYMPIC BLVD
Practice Address - Street 2:STE 101
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90019-3563
Practice Address - Country:US
Practice Address - Phone:323-766-1057
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2016-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA66714207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A667140Medicaid
CAWA66714AMedicare ID - Type Unspecified