Provider Demographics
NPI:1689766693
Name:CHUNG, BINH MINH (MD)
Entity Type:Individual
Prefix:
First Name:BINH
Middle Name:MINH
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 1:7345 S DURANGO DR B107 MAILBOX 52
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89113-3608
Mailing Address - Country:US
Mailing Address - Phone:170-236-0330
Mailing Address - Fax:170-273-6630
Practice Address - Street 1:7345 S DURANGO DR # B107
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89113-3608
Practice Address - Country:US
Practice Address - Phone:702-301-9123
Practice Address - Fax:702-240-0414
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2007-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV11281207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVI64452Medicare UPIN