Provider Demographics
NPI:1962510396
Name:CHUNG, SAMUEL JAEJIN (DO)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:JAEJIN
Last Name:CHUNG
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:2802 NORTH HIGHLAND AVENUE
Mailing Address - Street 2:SUITE C
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-1847
Mailing Address - Country:US
Mailing Address - Phone:731-660-3530
Mailing Address - Fax:731-660-3560
Practice Address - Street 1:2802 NORTH HIGHLAND AVENUE
Practice Address - Street 2:SUITE C
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-1847
Practice Address - Country:US
Practice Address - Phone:731-660-3530
Practice Address - Fax:731-660-3560
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TNDO1217208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNG10560Medicare UPIN