Provider Demographics
NPI:1528043403
Name:CHUNG, CHRIS (MD)
Entity Type:Individual
Prefix:
First Name:CHRIS
Middle Name:
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 1:900 LAFAYETTE ST STE 105
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARA
Mailing Address - State:CA
Mailing Address - Zip Code:95050-4966
Mailing Address - Country:US
Mailing Address - Phone:408-293-7767
Mailing Address - Fax:408-294-6595
Practice Address - Street 1:900 LAFAYETTE ST STE 105
Practice Address - Street 2:
Practice Address - City:SANTA CLARA
Practice Address - State:CA
Practice Address - Zip Code:95050
Practice Address - Country:US
Practice Address - Phone:408-293-7767
Practice Address - Fax:408-294-6595
Is Sole Proprietor?:No
Enumeration Date:2005-12-13
Last Update Date:2019-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA54870207Q00000X, 207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A548703Medicare PIN
CAG59273Medicare UPIN