Provider Demographics
NPI:1952383416
Name:CHUNG, SOO KIL (MD)
Entity Type:Individual
Prefix:
First Name:SOO
Middle Name:KIL
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 1:1700 WHITEHORSE HAMILTON SQUARE RD
Mailing Address - Street 2:
Mailing Address - City:HAMILTON SQUARE
Mailing Address - State:NJ
Mailing Address - Zip Code:08690-3536
Mailing Address - Country:US
Mailing Address - Phone:609-587-2020
Mailing Address - Fax:609-588-9545
Practice Address - Street 1:1700 WHITEHORSE HAMILTON SQUARE RD
Practice Address - Street 2:
Practice Address - City:HAMILTON SQUARE
Practice Address - State:NJ
Practice Address - Zip Code:08690-3536
Practice Address - Country:US
Practice Address - Phone:609-587-2020
Practice Address - Fax:609-588-9545
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2008-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05391300207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
0135776OtherGHI
001600636OtherAMERIHEALTH PPO
J23073OtherHEALTHNET
1774386OtherUNITED HEALTHCARE
1849321OtherFIRST HEALTH
NJ4594509Medicaid
2279367000OtherAMERIHEALTH HMO
NJ4594509Medicaid
1849321OtherFIRST HEALTH