Healthcare Provider Details

I. General information

NPI: 1245933068
Provider Name (Legal Business Name): BRIAN CHUNG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2023
Last Update Date: 07/11/2026
Certification Date: 07/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4029 165TH ST
FLUSHING NY
11358-2621
US

IV. Provider business mailing address

3360 STEVE REYNOLDS BLVD APT 2315
DULUTH GA
30096-4566
US

V. Phone/Fax

Practice location:
  • Phone: 718-551-8717
  • Fax:
Mailing address:
  • Phone: 718-551-8717
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number346038
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: