Provider Demographics
NPI:1306821434
Name:CHUN, MICKY (MD)
Entity Type:Individual
Prefix:
First Name:MICKY
Middle Name:
Last Name:CHUN
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 1:242 MERRICK RD
Mailing Address - Street 2:SUITE 304
Mailing Address - City:ROCKVILLE CENTRE
Mailing Address - State:NY
Mailing Address - Zip Code:11570-5254
Mailing Address - Country:US
Mailing Address - Phone:516-764-7070
Mailing Address - Fax:516-764-7073
Practice Address - Street 1:242 MERRICK RD
Practice Address - Street 2:SUITE 304
Practice Address - City:ROCKVILLE CENTRE
Practice Address - State:NY
Practice Address - Zip Code:11570-5254
Practice Address - Country:US
Practice Address - Phone:516-764-7070
Practice Address - Fax:516-764-7073
Is Sole Proprietor?:No
Enumeration Date:2005-12-13
Last Update Date:2009-10-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY227650207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02595802Medicaid
NY02595802Medicaid
H86700Medicare UPIN