Provider Demographics
NPI:1811190101
Name:YOUNHO CHUNG MD PC
Entity Type:Organization
Organization Name:YOUNHO CHUNG MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:ELAINE
Authorized Official - Middle Name:
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:810-230-7042
Mailing Address - Street 1:497 COLUMBIA AVE E STE 13
Mailing Address - Street 2:
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49014-5463
Mailing Address - Country:US
Mailing Address - Phone:269-969-6060
Mailing Address - Fax:
Practice Address - Street 1:497 COLUMBIA AVE E STE 13
Practice Address - Street 2:
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49014-5463
Practice Address - Country:US
Practice Address - Phone:269-969-6060
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-06
Last Update Date:2018-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301069853207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3464952Medicaid
MIP15870001Medicare PIN
MIG73664Medicare UPIN