Healthcare Provider Details

I. General information

NPI: 1659363232
Provider Name (Legal Business Name): DEBORAH B. CHUNG M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

Provider Other Name: DAE BONG KIM

II. Dates (important events)

Enumeration Date: 08/18/2005
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

223 MAIN ST
BEACON NY
12508-2770
US

IV. Provider business mailing address

29 N HAMILTON ST
POUGHKEEPSIE NY
12601-2541
US

V. Phone/Fax

Practice location:
  • Phone: 845-838-4900
  • Fax: 845-838-4915
Mailing address:
  • Phone: 845-452-1110
  • Fax: 845-452-1119

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number1270681-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: