MEDICARE: DR. DEREK GEORGE CHUNG M.D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	192240	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5100205	OTHER	NY	GHI
2	2Y8963	OTHER	NY	EMPIRE BC/BS
3	1903280	OTHER	NY	UNITED HEALTHCARE
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	P1883718	OTHER	NY	OXFORD

General Provider Information

NPI Number	:	1588747935
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DEREK GEORGE CHUNG M.D

Provider Business Mailing Address
First Line	:	1347 E 89TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11236-5121
Country	:	US
Telephone Number	:	718-258-3085
Fax Number	:	718-258-2039

Provider Business Practice Location Address
First Line	:	2244 CHURCH AVE FL 3
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11226-4195
Country	:	US
Telephone Number	:	718-352-0083
Fax Number	:	718-627-1525

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/21/2006
Last Update Date	:	02/14/2024

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