Organization
AVANTIS NEUROSCIENCE INC
Active
Organization
AVANTIS NEUROSCIENCE INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JEFFREY M CHUNG M.D. (CEO)
(323) 682-0182
Entity
Organization
Contact information
Practice address
12401 WILSHIRE BLVD STE 104, LOS ANGELES, CA 90025-1015
(323) 682-0182
Mailing address
1807 WILSHIRE BLVD STE A, SANTA MONICA, CA 90403-5678
Taxonomy
Speciality
Code
Description
License number
State
2084N0600X
Clinical Neurophysiology Physician
Primary
—
—
Other
Enumeration date
04/06/2017
Last updated
01/23/2020
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