Basic Information
| Provider Information | |||||||||
| NPI: | 1164692554 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHUNG | ||||||||
| FirstName: | BRIAN | ||||||||
| MiddleName: | JAEHOON | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 360 PHARR RD NE | ||||||||
| Address2: | #625 | ||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303052350 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2164016722 | ||||||||
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| Practice Location | |||||||||
| Address1: | 20 GLENLAKE PKWY NE | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303283473 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7706776137 | ||||||||
| FaxNumber: | 7706777332 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/03/2008 | ||||||||
| LastUpdateDate: | 04/13/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 04/13/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Y00000X | 061407 | GA | Y | Allopathic & Osteopathic Physicians | Otolaryngology |
No ID Information.