Provider Demographics
NPI:1770610909
Name:CHUNG, JEANNIE HYE-JOON (MD)
Entity type:Individual
Prefix:
First Name:JEANNIE
Middle Name:HYE-JOON
Last Name:CHUNG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:MA
Mailing Address - Zip Code:01970-2721
Mailing Address - Country:US
Mailing Address - Phone:978-744-3223
Mailing Address - Fax:978-744-4990
Practice Address - Street 1:107 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:MA
Practice Address - Zip Code:01970-2721
Practice Address - Country:US
Practice Address - Phone:978-744-3223
Practice Address - Fax:978-744-4990
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2010-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA220376207YX0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0007XAllopathic & Osteopathic PhysiciansOtolaryngologyPlastic Surgery within the Head & Neck
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3196615Medicaid
MA3631661OtherUS HEALTH
MACHJ28101OtherBLUE CROSS BLUE SHIELD
MA469790OtherTUFTS
MAAA18695OtherHARVARD PILGRIM
MA3631661OtherUS HEALTH
MAH90402Medicare UPIN