Basic Information
| Provider Information | |||||||||
| NPI: | 1740224765 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHUNG | ||||||||
| FirstName: | HUNG | ||||||||
| MiddleName: | SUP | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 501 CONCORD ST | ||||||||
| Address2: | |||||||||
| City: | DIX HILLS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117466831 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6312428073 | ||||||||
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| Practice Location | |||||||||
| Address1: | 115 CARLETON AVE | ||||||||
| Address2: | |||||||||
| City: | CENTRAL ISLIP | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117223619 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6312347807 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/16/2006 | ||||||||
| 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 | 2084P0800X | 125021-1 | NY | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
No ID Information.