Provider Demographics
NPI:1508949975
Name:CHUNG, WENDY WEI (MD)
Entity Type:Individual
Prefix:DR
First Name:WENDY
Middle Name:WEI
Last Name:CHUNG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4211 KISSENA BLVD APT 1C
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-3221
Mailing Address - Country:US
Mailing Address - Phone:718-886-0068
Mailing Address - Fax:718-961-8960
Practice Address - Street 1:4211 KISSENA BLVD APT 1C
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-3221
Practice Address - Country:US
Practice Address - Phone:718-886-0068
Practice Address - Fax:718-961-8960
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY189829208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01646955Medicaid
F44463Medicare UPIN