Provider Demographics
NPI:1063702702
Name:CHUNG, PAUL HWAN (MD)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:HWAN
Last Name:CHUNG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:833 CHESTNUT ST STE 703
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-4409
Mailing Address - Country:US
Mailing Address - Phone:215-955-1000
Mailing Address - Fax:215-923-2275
Practice Address - Street 1:833 CHESTNUT ST STE 703
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-4409
Practice Address - Country:US
Practice Address - Phone:215-955-1000
Practice Address - Fax:215-923-2275
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-14
Last Update Date:2020-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA10273100208800000X
PAMD460767208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103349031Medicaid
NJ674133Medicaid