Provider Demographics
NPI:1003208760
Name:CHUNG, OK
Entity Type:Individual
Prefix:
First Name:OK
Middle Name:
Last Name:CHUNG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21012 39TH AVE
Mailing Address - Street 2:3 FLOOR
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11361-1910
Mailing Address - Country:US
Mailing Address - Phone:718-225-2999
Mailing Address - Fax:
Practice Address - Street 1:21012 39TH AVE
Practice Address - Street 2:3 FLOOR
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11361-1910
Practice Address - Country:US
Practice Address - Phone:718-225-2999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-04
Last Update Date:2015-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030119183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist