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1578149670 NPI number — DEREK SHANE CHUNG DO

NPI Number: 1578149670
Health Care Provider/Practitioner: DEREK SHANE CHUNG DO

Information about “1578149670” NPI (DEREK SHANE CHUNG DO) exists in 1578149670 in HTML format HTML  |  1578149670 in plain Text format TXT  |  1578149670 in PDF (Portable Document Format) PDF  |  1578149670 in an XML format XML  formats.

NPI Number : 1578149670 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1578149670",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "CHUNG",
    "FirstName": "DEREK",
    "MiddleName": "SHANE",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "DO",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "30 N MARIO CAPECHHI DR RM 5N200",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "SALT LAKE CITY",
    "MailingAddressStateName": "UT",
    "MailingAddressPostalCode": "84112",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "801-581-2121",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "30 N MARIO CAPECHHI DR RM 5N200",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "SALT LAKE CITY",
    "PracticeLocationAddressStateName": "UT",
    "PracticeLocationAddressPostalCode": "84112",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "801-581-2121",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "03/20/2021",
    "LastUpdateDate": "12/29/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "207LP2900X",
        "TaxonomyName": "Pain Medicine (Anesthesiology) Physician",
        "LicenseNumber": "14209965-1204",
        "LicenseNumberStateCode": "UT",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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