MEDICARE: KI YOUNG CHUNG MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RH0003X	Hematology & Oncology Physician	33366	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1336110113
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KI YOUNG CHUNG MD

Provider Business Mailing Address
First Line	:	1 INDEPENDENCE PT STE 212
Second Line	:
City	:	GREENVILLE
State	:	SC
Zip	:	29615-4536
Country	:	US
Telephone Number	:	864-797-6303
Fax Number	:	864-797-6198

Provider Business Practice Location Address
First Line	:	120 DILLON DR
Second Line	:
City	:	SPARTANBURG
State	:	SC
Zip	:	29307-1018
Country	:	US
Telephone Number	:	864-699-5700
Fax Number	:	864-699-5701

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/30/2006
Last Update Date	:	01/31/2018

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Directions to “ KI YOUNG CHUNG MD” Practice Location

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