Provider Demographics
NPI:1962500413
Name:CHUNG, ANDREW D (MD)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:D
Last Name:CHUNG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3600 GASTON AVE
Mailing Address - Street 2:SUITE 755
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75246-1800
Mailing Address - Country:US
Mailing Address - Phone:214-823-4200
Mailing Address - Fax:214-823-4206
Practice Address - Street 1:3600 GASTON AVE
Practice Address - Street 2:SUITE 755
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75246-1800
Practice Address - Country:US
Practice Address - Phone:214-823-4200
Practice Address - Fax:214-823-4206
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2014-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK3134207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
5572534OtherAETNA
TX031482502Medicaid
TX043042301Medicaid
110158386OtherRR MEDICARE
845115OtherBCBS
845115OtherBCBS
TX031482502Medicaid