Provider Demographics
NPI:1881670685
Name:CHI, JUNG I (MD)
Entity type:Individual
Prefix:DR
First Name:JUNG
Middle Name:I
Last Name:CHI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:600 W CAMPBELL RD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-3385
Mailing Address - Country:US
Mailing Address - Phone:214-941-9672
Mailing Address - Fax:214-941-4746
Practice Address - Street 1:600 W CAMPBELL RD
Practice Address - Street 2:SUITE 4
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-3385
Practice Address - Country:US
Practice Address - Phone:214-941-9672
Practice Address - Fax:214-941-4746
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-22
Last Update Date:2010-03-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXF0416207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0986275-02Medicaid
TX000000NN72OtherBLUECROSS BLUESHIELD
TX8F9318Medicare PIN
TXC14432Medicare UPIN