Provider Demographics
NPI:1205866845
Name:CHAE, KYU C (MD)
Entity Type:Individual
Prefix:MR
First Name:KYU
Middle Name:C
Last Name:CHAE
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 1:123 S MUNN AVE
Mailing Address - Street 2:
Mailing Address - City:E ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07018
Mailing Address - Country:US
Mailing Address - Phone:973-674-8168
Mailing Address - Fax:973-674-2520
Practice Address - Street 1:123 S MUNN AVE
Practice Address - Street 2:
Practice Address - City:E ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07018
Practice Address - Country:US
Practice Address - Phone:973-674-8168
Practice Address - Fax:973-674-2520
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ29521208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2095009Medicaid
C55812Medicare UPIN
456421Medicare ID - Type Unspecified