Healthcare Provider Details

I. General information

NPI: 1417990268
Provider Name (Legal Business Name): YONG-SUNG CHYUN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2006
Last Update Date: 04/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 FARMINGTON AVE SUITE 201
BRISTOL CT
06010-3990
US

IV. Provider business mailing address

1001 FARMINGTON AVE SUITE 201
BRISTOL CT
06010-3990
US

V. Phone/Fax

Practice location:
  • Phone: 860-582-1100
  • Fax: 560-582-8368
Mailing address:
  • Phone: 860-582-1100
  • Fax: 560-582-8368

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number021696
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number021696
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: