Healthcare Provider Details

I. General information

NPI: 1821170150
Provider Name (Legal Business Name): TAEHYUN PHILIP CHUNG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 07/31/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3838 CALIFORNIA ST SUITE 616
SAN FRANCISCO CA
94118-1522
US

IV. Provider business mailing address

3838 CALIFORNIA ST SUITE 616
SAN FRANCISCO CA
94118-1522
US

V. Phone/Fax

Practice location:
  • Phone: 415-668-0411
  • Fax: 415-668-6352
Mailing address:
  • Phone: 415-668-0411
  • Fax: 415-668-6352

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberA104629
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License NumberA104629
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: