Basic Information
| Provider Information | |||||||||
| NPI: | 1336364306 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHUNG | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | BYUNGHAK | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5810 S 300 E | ||||||||
| Address2: | #300 | ||||||||
| City: | MURRAY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 84107 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8013142308 | ||||||||
| FaxNumber: | 8013142413 | ||||||||
| Practice Location | |||||||||
| Address1: | 5810 S 300 E | ||||||||
| Address2: | #300 | ||||||||
| City: | MURRAY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 84107 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8013142308 | ||||||||
| FaxNumber: | 8013142413 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/16/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208100000X | 3323301205 | UT | Y | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |
ID Information
| ID | Type | State | Issuer | Description | 3323301205 | 01 | UT | PHYSICIAN SURGEON | OTHER |