Provider Demographics
NPI:1801891379
Name:CHUNG, CHRISTIAN Y (MD)
Entity type:Individual
Prefix:DR
First Name:CHRISTIAN
Middle Name:Y
Last Name:CHUNG
Suffix:
Gender:M
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:PO BOX 87388
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-7388
Mailing Address - Country:US
Mailing Address - Phone:910-323-2477
Mailing Address - Fax:910-323-5931
Practice Address - Street 1:1880 QUIET CV
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-3857
Practice Address - Country:US
Practice Address - Phone:910-323-2477
Practice Address - Fax:910-323-5931
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-20
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC33631174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8922468Medicaid
NC213811Medicare ID - Type Unspecified
NC8922468Medicaid