Provider Demographics
NPI:1720489297
Name:CHUNG, TRUNG PHU (PA-C)
Entity Type:Individual
Prefix:
First Name:TRUNG
Middle Name:PHU
Last Name:CHUNG
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2908
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97208-2908
Mailing Address - Country:US
Mailing Address - Phone:252-075-1554
Mailing Address - Fax:
Practice Address - Street 1:4816 NW BETHANY BLVD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97229-9254
Practice Address - Country:US
Practice Address - Phone:888-227-3312
Practice Address - Fax:971-282-0100
Is Sole Proprietor?:No
Enumeration Date:2014-09-15
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORPA174588363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant