Provider Demographics
NPI:1003258955
Name:CHUNG, KEVIN C (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:C
Last Name:CHUNG
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 E 170TH ST
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10452-7013
Mailing Address - Country:US
Mailing Address - Phone:718-588-6825
Mailing Address - Fax:
Practice Address - Street 1:32 E 170TH ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10452-7013
Practice Address - Country:US
Practice Address - Phone:718-588-6825
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-20
Last Update Date:2013-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY056876183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist