Provider Demographics
NPI:1770050437
Name:CHUNG, HYE HYUN
Entity type:Individual
Prefix:
First Name:HYE HYUN
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 1:19 CAMBRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:ROSLYN HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11577
Mailing Address - Country:US
Mailing Address - Phone:516-662-8981
Mailing Address - Fax:516-277-1431
Practice Address - Street 1:19 CAMBRIDGE ST
Practice Address - Street 2:
Practice Address - City:ROSLYN HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11577
Practice Address - Country:US
Practice Address - Phone:516-662-8981
Practice Address - Fax:516-277-1431
Is Sole Proprietor?:No
Enumeration Date:2018-10-30
Last Update Date:2018-11-16
Deactivation Date:2018-10-30
Deactivation Code:
Reactivation Date:2018-11-16
Provider Licenses
StateLicense IDTaxonomies
NY005262171100000X
NY005962171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist