Healthcare Provider Details

I. General information

NPI: 1326264334
Provider Name (Legal Business Name): JEFF B CHUNG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5810 SOUTH 300 EAST SUITE 300
MURRAY UT
84107
US

IV. Provider business mailing address

5810 SOUTH 300 EAST SUITE 300
MURRAY UT
84107
US

V. Phone/Fax

Practice location:
  • Phone: 801-314-2308
  • Fax: 801-314-2413
Mailing address:
  • Phone: 801-314-2308
  • Fax: 801-314-2413

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number2636218905
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: