Provider Demographics
NPI:1922320605
Name:CHUNG, JIN H
Entity Type:Individual
Prefix:
First Name:JIN
Middle Name:H
Last Name:CHUNG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4120 HEMPSTEAD TPKE
Mailing Address - Street 2:
Mailing Address - City:BETHPAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11714-5600
Mailing Address - Country:US
Mailing Address - Phone:516-520-8809
Mailing Address - Fax:516-520-2958
Practice Address - Street 1:210 S BROADWAY
Practice Address - Street 2:
Practice Address - City:HICKSVILLE
Practice Address - State:NY
Practice Address - Zip Code:11801-5002
Practice Address - Country:US
Practice Address - Phone:516-433-2711
Practice Address - Fax:512-681-6422
Is Sole Proprietor?:No
Enumeration Date:2010-02-22
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY48408183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist