Provider Demographics
NPI:1164692554
Name:CHUNG, BRIAN JAEHOON (MD)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:JAEHOON
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 1:360 PHARR RD NE
Mailing Address - Street 2:#625
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30305-2350
Mailing Address - Country:US
Mailing Address - Phone:216-401-6722
Mailing Address - Fax:
Practice Address - Street 1:20 GLENLAKE PKWY NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328-3473
Practice Address - Country:US
Practice Address - Phone:770-677-6137
Practice Address - Fax:770-677-7332
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-03
Last Update Date:2022-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA061407207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology