Provider Demographics
NPI:1639146061
Name:CHUNG, AUBREY JOSPEH JR (MD)
Entity Type:Individual
Prefix:
First Name:AUBREY
Middle Name:JOSPEH
Last Name:CHUNG
Suffix:JR
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 1:15216 N 15TH DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85023-5185
Mailing Address - Country:US
Mailing Address - Phone:602-548-6300
Mailing Address - Fax:
Practice Address - Street 1:13907 W CAMINO DEL SOL
Practice Address - Street 2:SUITE 101
Practice Address - City:SUN CITY WEST
Practice Address - State:AZ
Practice Address - Zip Code:85375-4405
Practice Address - Country:US
Practice Address - Phone:623-584-4695
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-03
Last Update Date:2011-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ22436174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ169947Medicaid
AZWMBDD02Medicare ID - Type UnspecifiedMEDICARE PROVIDER ID NUMB
F81030Medicare UPIN