Provider Demographics
NPI:1669404653
Name:CHUNG, WAYNE (MD)
Entity type:Individual
Prefix:DR
First Name:WAYNE
Middle Name:
Last Name:CHUNG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2173 CALIFORNIA ST
Mailing Address - Street 2:APT 103
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94115-2874
Mailing Address - Country:US
Mailing Address - Phone:415-359-0548
Mailing Address - Fax:415-835-1280
Practice Address - Street 1:1 EMBARCADERO CTR STE 500
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94111-3610
Practice Address - Country:US
Practice Address - Phone:415-835-1279
Practice Address - Fax:415-835-1280
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA63888207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG76647Medicare UPIN