Provider Demographics
NPI:1639178502
Name:CHUNG, DAVID S (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:S
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 1:370 OAK ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-1341
Mailing Address - Country:US
Mailing Address - Phone:508-584-1234
Mailing Address - Fax:508-584-0230
Practice Address - Street 1:370 OAK ST
Practice Address - Street 2:SUITE A
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-1341
Practice Address - Country:US
Practice Address - Phone:508-584-1234
Practice Address - Fax:508-584-0230
Is Sole Proprietor?:No
Enumeration Date:2005-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA204569208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics