Provider Demographics
NPI:1235364647
Name:CHUNG, CHANKUN KENNETH (MD)
Entity Type:Individual
Prefix:MR
First Name:CHANKUN
Middle Name:KENNETH
Last Name:CHUNG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4 TIFFANY DRIVE
Mailing Address - Street 2:
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18505-2311
Mailing Address - Country:US
Mailing Address - Phone:570-344-9638
Mailing Address - Fax:570-344-9638
Practice Address - Street 1:4 TIFFANY DRIVE
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18505-2311
Practice Address - Country:US
Practice Address - Phone:570-344-9638
Practice Address - Fax:570-344-9638
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-29
Last Update Date:2009-05-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD035109L208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery