Provider Demographics
NPI:1275504714
Name:CHUNG, HETTY (MD)
Entity Type:Individual
Prefix:DR
First Name:HETTY
Middle Name:
Last Name:CHUNG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3111 NEW HYDE PARK RD
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11042-1217
Mailing Address - Country:US
Mailing Address - Phone:516-365-6100
Mailing Address - Fax:516-365-0374
Practice Address - Street 1:3111 NEW HYDE PARK RD
Practice Address - Street 2:
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11042-1217
Practice Address - Country:US
Practice Address - Phone:516-365-6100
Practice Address - Fax:516-365-0374
Is Sole Proprietor?:No
Enumeration Date:2006-02-01
Last Update Date:2013-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY225508207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY100271Medicare UPIN
NY682E51Medicare ID - Type Unspecified