Provider Demographics
NPI:1437379518
Name:CHUNG, LAP PANG BENNY (RPA-C)
Entity Type:Individual
Prefix:MR
First Name:LAP PANG BENNY
Middle Name:
Last Name:CHUNG
Suffix:
Gender:M
Credentials:RPA-C
Other - Prefix:MR
Other - First Name:BENNY
Other - Middle Name:LAP PANG
Other - Last Name:CHUNG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RPA-C
Mailing Address - Street 1:167 SANDS ST APT 509
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-7414
Mailing Address - Country:US
Mailing Address - Phone:718-625-4928
Mailing Address - Fax:
Practice Address - Street 1:14601 45TH AVE
Practice Address - Street 2:SUITE 206
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-2200
Practice Address - Country:US
Practice Address - Phone:718-670-3135
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-30
Last Update Date:2013-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006599363AM0700X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical