Provider Demographics
NPI:1073843181
Name:ANDREW CHUNG MD PLLC
Entity Type:Organization
Organization Name:ANDREW CHUNG MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:D
Authorized Official - Last Name:CHUNG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-823-4200
Mailing Address - Street 1:3600 GASTON AVE
Mailing Address - Street 2:STE 755
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75246-1800
Mailing Address - Country:US
Mailing Address - Phone:214-823-4200
Mailing Address - Fax:
Practice Address - Street 1:3600 GASTON AVE
Practice Address - Street 2:SUITE 755
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75246-1800
Practice Address - Country:US
Practice Address - Phone:214-823-4200
Practice Address - Fax:214-823-4206
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-12
Last Update Date:2015-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK3134207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX280440301Medicaid
TXDR4565Medicare PIN
TXTXB107651Medicare PIN
TXG69819Medicare UPIN