Provider Demographics
NPI:1609971803
Name:CHUNG, MYUNG K (MD)
Entity Type:Individual
Prefix:
First Name:MYUNG
Middle Name:K
Last Name:CHUNG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 MARTER AVE
Mailing Address - Street 2:SUITE 507
Mailing Address - City:MOORESTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08057-3124
Mailing Address - Country:US
Mailing Address - Phone:856-222-4766
Mailing Address - Fax:856-222-1137
Practice Address - Street 1:110 MARTER AVE
Practice Address - Street 2:SUITE 507
Practice Address - City:MOORESTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08057-3124
Practice Address - Country:US
Practice Address - Phone:856-222-4766
Practice Address - Fax:856-222-1137
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJMA54258207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5078008Medicaid
C32850Medicare UPIN
NJ175855Medicare ID - Type Unspecified