Provider Demographics
NPI:1376552778
Name:CHUNG, DAVID S (DPM)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:S
Last Name:CHUNG
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4055 SW 185TH AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ALOHA
Mailing Address - State:OR
Mailing Address - Zip Code:97078-1567
Mailing Address - Country:US
Mailing Address - Phone:503-591-7449
Mailing Address - Fax:503-591-5826
Practice Address - Street 1:4055 SW 185TH AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:ALOHA
Practice Address - State:OR
Practice Address - Zip Code:97078-1567
Practice Address - Country:US
Practice Address - Phone:503-591-7449
Practice Address - Fax:503-591-5826
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2014-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDP00157213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR118646Medicaid
ORT67509Medicare UPIN
OR118646Medicaid