Provider Demographics
NPI:1285670059
Name:CHUNG, HAEYANG (MD)
Entity Type:Individual
Prefix:
First Name:HAEYANG
Middle Name:
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 1:11 E HARWOOD TER
Mailing Address - Street 2:
Mailing Address - City:PALISADES PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07650-1424
Mailing Address - Country:US
Mailing Address - Phone:201-313-1500
Mailing Address - Fax:201-941-4157
Practice Address - Street 1:11 E HARWOOD TER
Practice Address - Street 2:
Practice Address - City:PALISADES PARK
Practice Address - State:NJ
Practice Address - Zip Code:07650-1424
Practice Address - Country:US
Practice Address - Phone:201-313-1500
Practice Address - Fax:201-941-4157
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-21
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA5927500207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ063113Medicare PIN
F62557Medicare UPIN