Provider Demographics
NPI:1801320114
Name:CHUNG, DICK (DPM)
Entity type:Individual
Prefix:DR
First Name:DICK
Middle Name:
Last Name:CHUNG
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:506 6TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-3609
Mailing Address - Country:US
Mailing Address - Phone:718-780-5716
Mailing Address - Fax:718-780-3095
Practice Address - Street 1:769 54TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11220-3282
Practice Address - Country:US
Practice Address - Phone:718-851-0495
Practice Address - Fax:718-436-2681
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-13
Last Update Date:2020-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007096213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery