Healthcare Provider Details

I. General information

NPI: 1932739612
Provider Name (Legal Business Name): DENNY CHUNG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2020
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date: 03/17/2023
Reactivation Date: 05/08/2023

III. Provider practice location address

490 MURPHY RD
MEDFORD OR
97504-8144
US

IV. Provider business mailing address

490 MURPHY RD
MEDFORD OR
97504-8144
US

V. Phone/Fax

Practice location:
  • Phone: 541-779-5227
  • Fax:
Mailing address:
  • Phone: 541-779-5227
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberDP231272
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: