Provider Demographics
NPI:1841275518
Name:CHUNG, HENRY (MD)
Entity type:Individual
Prefix:
First Name:HENRY
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:NEW YORK UNIVERSITY STUDENT HEALTH
Mailing Address - Street 2:726 BROADWAY, RM 474E
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003
Mailing Address - Country:US
Mailing Address - Phone:212-443-1033
Mailing Address - Fax:212-443-1031
Practice Address - Street 1:NEW YORK UNIVERSITY STUDENT HEALTH
Practice Address - Street 2:726 BROADWAY, RM 474E
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003
Practice Address - Country:US
Practice Address - Phone:212-443-1033
Practice Address - Fax:212-443-1031
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1841192084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
F57598Medicare UPIN