Provider Demographics
NPI:1972575918
Name:CHUNG, CLARA K I (MD)
Entity Type:Individual
Prefix:MRS
First Name:CLARA
Middle Name:K
Last Name:CHUNG
Suffix:I
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3125 INDEPENDENCE DR
Mailing Address - Street 2:SUITE 210
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35209-4159
Mailing Address - Country:US
Mailing Address - Phone:205-943-1197
Mailing Address - Fax:
Practice Address - Street 1:3125 INDEPENDENCE DR
Practice Address - Street 2:SUITE 210
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35209-4159
Practice Address - Country:US
Practice Address - Phone:205-943-1197
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-03
Last Update Date:2011-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL16114174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009982440Medicaid
AL51537273OtherBLUE CROSS BLUE SHIELD
AL009982440Medicaid
AL051506519Medicare ID - Type Unspecified