Provider Demographics
NPI:1477657088
Name:CHUNG, KYUNG H (MD)
Entity Type:Individual
Prefix:
First Name:KYUNG
Middle Name:H
Last Name:CHUNG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Last Name:
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Mailing Address - Street 1:2139 SILAS DEANE HWY
Mailing Address - Street 2:
Mailing Address - City:ROCKY HILL
Mailing Address - State:CT
Mailing Address - Zip Code:06067-2336
Mailing Address - Country:US
Mailing Address - Phone:860-257-4131
Mailing Address - Fax:860-257-4519
Practice Address - Street 1:21 SOUTH RD
Practice Address - Street 2:SUITE 100
Practice Address - City:FARMINGTON
Practice Address - State:CT
Practice Address - Zip Code:06032-2410
Practice Address - Country:US
Practice Address - Phone:860-409-4567
Practice Address - Fax:860-409-4846
Is Sole Proprietor?:No
Enumeration Date:2006-09-12
Last Update Date:2011-04-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT021395207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT110005995Medicare PIN
D02757Medicare UPIN