Provider Demographics
NPI:1326264334
Name:CHUNG, JEFF B (MD)
Entity Type:Individual
Prefix:
First Name:JEFF
Middle Name:B
Last Name:CHUNG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:5810 SOUTH 300 EAST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84107
Mailing Address - Country:US
Mailing Address - Phone:801-314-2308
Mailing Address - Fax:801-314-2413
Practice Address - Street 1:5810 SOUTH 300 EAST
Practice Address - Street 2:SUITE 300
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107
Practice Address - Country:US
Practice Address - Phone:801-314-2308
Practice Address - Fax:801-314-2413
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
UT2636218905208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation