Provider Demographics
NPI:1235394842
Name:YU, CHUNG CHI (MD)
Entity Type:Individual
Prefix:DR
First Name:CHUNG CHI
Middle Name:
Last Name:YU
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 1:23 OCEANIC AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10312-6511
Mailing Address - Country:US
Mailing Address - Phone:718-948-8880
Mailing Address - Fax:718-967-6040
Practice Address - Street 1:23 OCEANIC AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10312-6511
Practice Address - Country:US
Practice Address - Phone:718-948-8880
Practice Address - Fax:718-967-6040
Is Sole Proprietor?:No
Enumeration Date:2008-07-23
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY256042-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA400050204Medicare PIN