Provider Demographics
NPI:1003022419
Name:CHRIS CHUNG, MD, INC.
Entity Type:Organization
Organization Name:CHRIS CHUNG, MD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:ENCHUL
Authorized Official - Last Name:CHUNG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:408-293-7767
Mailing Address - Street 1:455 OCONNOR DR
Mailing Address - Street 2:#150
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-1633
Mailing Address - Country:US
Mailing Address - Phone:408-293-7767
Mailing Address - Fax:408-294-6595
Practice Address - Street 1:455 OCONNOR DR
Practice Address - Street 2:#150
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-1633
Practice Address - Country:US
Practice Address - Phone:408-293-7767
Practice Address - Fax:408-294-6595
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA54870207Q00000X, 207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Not Answered207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG59273Medicare UPIN
CA00A548700Medicare ID - Type Unspecified