Healthcare Provider Details

I. General information

NPI: 1679735724
Provider Name (Legal Business Name): GRACE CHUNG M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2008
Last Update Date: 05/02/2022
Certification Date: 05/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1320 STONY BROOK ROAD BUILDING D, SUITE 100
STONY BROOK NY
11790
US

IV. Provider business mailing address

40 RESEARCH WAY SUITE 105
EAST SETAUKET NY
11733-3523
US

V. Phone/Fax

Practice location:
  • Phone: 631-941-2273
  • Fax: 631-941-2501
Mailing address:
  • Phone: 631-872-8279
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number125054265
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number273197-1
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number273197-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: