Healthcare Provider Details

I. General information

NPI: 1447367966
Provider Name (Legal Business Name): HANKYU CHUNG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/23/2006
Last Update Date: 08/23/2024
Certification Date: 08/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2039 FOREST AVE SUITE 303
SAN JOSE CA
95128-4817
US

IV. Provider business mailing address

2039 FOREST AVE SUITE 303
SAN JOSE CA
95128-4817
US

V. Phone/Fax

Practice location:
  • Phone: 408-297-8600
  • Fax: 408-297-5643
Mailing address:
  • Phone: 408-297-8600
  • Fax: 408-297-5643

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberA31980
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA31980
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: