MEDICARE: DAVID CHUNG

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	367500000X	Certified Registered Nurse Anesthetist	26NJ01391200	NJ
2	367500000X	Certified Registered Nurse Anesthetist	610348	NY

General Provider Information

NPI Number	:	1700291960
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID CHUNG

Provider Business Mailing Address
First Line	:	398 QUEENS CT
Second Line	:
City	:	RIDGEWOOD
State	:	NJ
Zip	:	07450-2012
Country	:	US
Telephone Number	:	646-245-1066
Fax Number	:

Provider Business Practice Location Address
First Line	:	398 QUEENS CT
Second Line	:
City	:	RIDGEWOOD
State	:	NJ
Zip	:	07450-2012
Country	:	US
Telephone Number	:	646-245-1066
Fax Number	:

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

Provider Enumeration Date	:	06/26/2014
Last Update Date	:	12/19/2024

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Directions to “ DAVID CHUNG ” Practice Location

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