Provider Demographics
NPI:1255494100
Name:CHUNG, JANJSIK WILLIAM J (MD)
Entity Type:Individual
Prefix:
First Name:JANJSIK WILLIAM
Middle Name:J
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 1:930 W AVON RD STE 17
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48307-2759
Mailing Address - Country:US
Mailing Address - Phone:248-651-5454
Mailing Address - Fax:248-651-3841
Practice Address - Street 1:930 W AVON RD
Practice Address - Street 2:#17
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307-2759
Practice Address - Country:US
Practice Address - Phone:248-651-5454
Practice Address - Fax:248-651-3841
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI365412080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine