Provider Demographics
NPI:1699834721
Name:KUNG, DAVID CY (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:CY
Last Name:KUNG
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 1:45 TALERICO RD
Mailing Address - Street 2:
Mailing Address - City:HORSEHEADS
Mailing Address - State:NY
Mailing Address - Zip Code:14845-8522
Mailing Address - Country:US
Mailing Address - Phone:607-734-2574
Mailing Address - Fax:607-734-3303
Practice Address - Street 1:300 MADISON AVE
Practice Address - Street 2:
Practice Address - City:ELMIRA
Practice Address - State:NY
Practice Address - Zip Code:14901-2813
Practice Address - Country:US
Practice Address - Phone:607-734-2574
Practice Address - Fax:607-734-3303
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2010-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY145 874174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY50311BOtherP/TAN
NY00602988Medicaid
NYB82824Medicare UPIN