Healthcare Provider Details

I. General information

NPI: 1962146316
Provider Name (Legal Business Name): BRANDON HAEYONG CHUNG DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2022
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 JARRETT WHITE RD
TRIPLER ARMY MEDICAL CENTER HI
96859-5001
US

IV. Provider business mailing address

18511 HIGHLANDER MEDICS ST
EL PASO TX
79906-5327
US

V. Phone/Fax

Practice location:
  • Phone: 808-433-2474
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberU5372
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: