Healthcare Provider Details

I. General information

NPI: 1003022419
Provider Name (Legal Business Name): CHRIS CHUNG, MD, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

455 OCONNOR DR #150
SAN JOSE CA
95128-1633
US

IV. Provider business mailing address

455 OCONNOR DR #150
SAN JOSE CA
95128-1633
US

V. Phone/Fax

Practice location:
  • Phone: 408-293-7767
  • Fax: 408-294-6595
Mailing address:
  • Phone: 408-293-7767
  • Fax: 408-294-6595

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA54870
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberA54870
License Number StateCA

VIII. Authorized Official

Name: CHRIS ENCHUL CHUNG
Title or Position: CEO
Credential:
Phone: 408-293-7767