Healthcare Provider Details

I. General information

NPI: 1700291960
Provider Name (Legal Business Name): DAVID CHUNG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2014
Last Update Date: 12/19/2024
Certification Date: 12/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

398 QUEENS CT
RIDGEWOOD NJ
07450-2012
US

IV. Provider business mailing address

398 QUEENS CT
RIDGEWOOD NJ
07450-2012
US

V. Phone/Fax

Practice location:
  • Phone: 646-245-1066
  • Fax:
Mailing address:
  • Phone: 646-245-1066
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number26NJ01391200
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number610348
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: