Provider Demographics
NPI:1396952826
Name:CHUNG, SUE
Entity type:Individual
Prefix:
First Name:SUE
Middle Name:
Last Name:CHUNG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21907 67TH AVE
Mailing Address - Street 2:APT # C
Mailing Address - City:OAKLAND GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11364-2638
Mailing Address - Country:US
Mailing Address - Phone:718-428-2426
Mailing Address - Fax:
Practice Address - Street 1:750 PARK PL # 790
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:NY
Practice Address - Zip Code:11561-2110
Practice Address - Country:US
Practice Address - Phone:516-536-0800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0393771835G0303X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835G0303XPharmacy Service ProvidersPharmacistGeriatric