Provider Demographics
NPI:1841399615
Name:CHUNG, SUSAN (MD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:
Last Name:CHUNG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:HI
Other - Last Name:SOHN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6301 S MCCLINTOCK DR
Mailing Address - Street 2:#101
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85283-3392
Mailing Address - Country:US
Mailing Address - Phone:480-214-2300
Mailing Address - Fax:480-214-2301
Practice Address - Street 1:60 S KYRENE RD
Practice Address - Street 2:#1
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85226-4685
Practice Address - Country:US
Practice Address - Phone:480-785-8700
Practice Address - Fax:480-785-8787
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2012-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ30500208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
00014245OtherBANNER HEALTH PLAN
1Z65553OtherHEALTHNET
AZ713439OtherAHCCCS
7134390OtherDES
713439001OtherAPIPA
AZ0719840OtherBLUE CROSS BLUE SHIELD