Provider Demographics
NPI:1134224926
Name:CHUNG, JOHN WONKOOK (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:WONKOOK
Last Name:CHUNG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1450 PARKSIDE AVENUE
Mailing Address - Street 2:SUITE 5
Mailing Address - City:TRENTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08638-2949
Mailing Address - Country:US
Mailing Address - Phone:609-882-2225
Mailing Address - Fax:609-538-0177
Practice Address - Street 1:1450 PARKSIDE AVENUE
Practice Address - Street 2:SUITE 5
Practice Address - City:TRENTON
Practice Address - State:NJ
Practice Address - Zip Code:08638-2949
Practice Address - Country:US
Practice Address - Phone:609-882-2225
Practice Address - Fax:609-538-0177
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ55467207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJD062412OtherCDS
NJ6036805Medicaid
NJ6036805Medicaid
NJBC3626782OtherDEA
NJ6036805Medicaid