Provider Demographics
NPI:1164449666
Name:CHUNG, ANDY TUAN ANH (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDY
Middle Name:TUAN ANH
Last Name:CHUNG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 689022
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37068-9022
Mailing Address - Country:US
Mailing Address - Phone:615-465-7385
Mailing Address - Fax:
Practice Address - Street 1:400 HOSPITAL DR STE 100
Practice Address - Street 2:
Practice Address - City:CORSICANA
Practice Address - State:TX
Practice Address - Zip Code:75110-2489
Practice Address - Country:US
Practice Address - Phone:903-641-4270
Practice Address - Fax:903-875-1515
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004034263207YX0007X
TXN2033207YX0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0007XAllopathic & Osteopathic PhysiciansOtolaryngologyPlastic Surgery within the Head & Neck
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO76480330Medicaid
CO017257OtherKAISER COMMERCIAL
I30061Medicare UPIN
CO76480330Medicaid