Provider Demographics
NPI:1184222077
Name:CHUNG, HYUN JIN (PHD)
Entity Type:Individual
Prefix:DR
First Name:HYUN JIN
Middle Name:
Last Name:CHUNG
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 HAMPDEN RD
Mailing Address - Street 2:
Mailing Address - City:EAST FALMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02536-6457
Mailing Address - Country:US
Mailing Address - Phone:401-575-0381
Mailing Address - Fax:
Practice Address - Street 1:789 PARK AVE
Practice Address - Street 2:
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02910-2036
Practice Address - Country:US
Practice Address - Phone:401-421-4561
Practice Address - Fax:401-243-3001
Is Sole Proprietor?:No
Enumeration Date:2020-10-13
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPS01854103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent