Provider Demographics
NPI:1831161629
Name:CHUNG, SUJIN (MD)
Entity type:Individual
Prefix:MR
First Name:SUJIN
Middle Name:
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 1:1547 S WAYNE
Mailing Address - Street 2:
Mailing Address - City:WESTLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48186
Mailing Address - Country:US
Mailing Address - Phone:734-729-3133
Mailing Address - Fax:734-729-3130
Practice Address - Street 1:1547 S WAYNE
Practice Address - Street 2:
Practice Address - City:WESTLAND
Practice Address - State:MI
Practice Address - Zip Code:48186-5436
Practice Address - Country:US
Practice Address - Phone:734-729-3133
Practice Address - Fax:734-729-3130
Is Sole Proprietor?:No
Enumeration Date:2006-02-06
Last Update Date:2025-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010349622084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
0829179OtherBLUE CROSS
MI101092221Medicaid
ON15280005OtherMEDICARE
MI101092221Medicaid
0829179Medicare PIN