Healthcare Provider Details

I. General information

NPI: 1346878170
Provider Name (Legal Business Name): MICHAEL YOUNG-WOON CHUNG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2020
Last Update Date: 06/10/2024
Certification Date: 06/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2358 LIFESTYLE WAY STE 212
CHATTANOOGA TN
37421-4904
US

IV. Provider business mailing address

141 BLACKBERRY WAY
DALTON GA
30720-7215
US

V. Phone/Fax

Practice location:
  • Phone: 423-521-1100
  • Fax:
Mailing address:
  • Phone: 706-483-6301
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number71218
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: