Healthcare Provider Details

I. General information

NPI: 1831532365
Provider Name (Legal Business Name): JULIAN KUNWOO CHUNG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/15/2013
Last Update Date: 08/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SW ARCHER RD
GAINESVILLE FL
32610-0001
US

IV. Provider business mailing address

1600 SW ARCHER RD
GAINESVILLE FL
32610-0001
US

V. Phone/Fax

Practice location:
  • Phone: 352-273-8737
  • Fax: 352-273-9154
Mailing address:
  • Phone: 352-273-8737
  • Fax: 352-273-9154

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberME141188
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: