=====================================================
General NPI Number Information
=====================================================
NPI Number | 1609835545
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | YOUNHO CHUNG
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/20/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 719 CAPITAL AVE SW
-----------------------------------------------------
City | BATTLE CREEK
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49015-5023
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 269-969-6060
-----------------------------------------------------
Fax | 269-965-7710
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 719 CAPITAL AVE SW
-----------------------------------------------------
City | BATTLE CREEK
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49015-5023
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 269-969-6060
-----------------------------------------------------
Fax | 269-965-7710
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHYSICIAN EMPLOYEE
-----------------------------------------------------
Name | MR. JOHN R YOUNG
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 269-969-6060
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------