Provider Demographics
NPI:1356329148
Name:CHUNG, KEE YOUNG (MD)
Entity Type:Individual
Prefix:
First Name:KEE
Middle Name:YOUNG
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:PO BOX 417400
Mailing Address - Street 2:NEWTON WELLESLEY RADIOLOGY ASSOCIATES
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-0001
Mailing Address - Country:US
Mailing Address - Phone:800-360-4391
Mailing Address - Fax:770-776-5702
Practice Address - Street 1:2014 WASHINGTON ST
Practice Address - Street 2:NEWTON WELLESLEY RADIOLOGY ASSOCIATES
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02462
Practice Address - Country:US
Practice Address - Phone:617-243-6600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-03
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1518022085B0100X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody Imaging
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0141780Medicaid
MA0141780Medicaid
F23108Medicare UPIN