Provider Demographics
NPI:1184873887
Name:CHUNG-HUSSAIN, HELEN K (DO)
Entity type:Individual
Prefix:
First Name:HELEN
Middle Name:K
Last Name:CHUNG-HUSSAIN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:HELEN
Other - Middle Name:K
Other - Last Name:CHUNG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:782 OLD HICKORY BLVD STE 203
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-4574
Mailing Address - Country:US
Mailing Address - Phone:615-371-1619
Mailing Address - Fax:615-371-8420
Practice Address - Street 1:782 OLD HICKORY BLVD STE 203
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-4574
Practice Address - Country:US
Practice Address - Phone:615-371-1619
Practice Address - Fax:615-371-8420
Is Sole Proprietor?:No
Enumeration Date:2008-09-17
Last Update Date:2014-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY254806207Q00000X
390200000X
TNDO0000002579207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03359166Medicaid
NYJ400057334Medicare PIN