Provider Demographics
NPI:1437221306
Name:CHUNG, KAI B (MD)
Entity Type:Individual
Prefix:
First Name:KAI
Middle Name:B
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 1:8 MICHAEL ROAD
Mailing Address - Street 2:
Mailing Address - City:SICKLERVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08081
Mailing Address - Country:US
Mailing Address - Phone:856-309-8660
Mailing Address - Fax:
Practice Address - Street 1:1676 E LANDIS AVE
Practice Address - Street 2:
Practice Address - City:VINELAND
Practice Address - State:NJ
Practice Address - Zip Code:08361
Practice Address - Country:US
Practice Address - Phone:856-696-6431
Practice Address - Fax:856-794-5803
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2012-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA 032024208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ129336B1HOtherMEDICARE BILLING ID
NJ4474201Medicaid
NJ4474201Medicaid