Provider Demographics
NPI:1124240080
Name:CHUNG, NANCY MEONGJU (MD)
Entity type:Individual
Prefix:DR
First Name:NANCY
Middle Name:MEONGJU
Last Name:CHUNG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:NANCY
Other - Middle Name:M
Other - Last Name:CHUNG SHANG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:413 W BETHEL RD STE 100
Mailing Address - Street 2:
Mailing Address - City:COPPELL
Mailing Address - State:TX
Mailing Address - Zip Code:75019-4474
Mailing Address - Country:US
Mailing Address - Phone:972-712-3131
Mailing Address - Fax:972-712-7171
Practice Address - Street 1:413 W BETHEL RD STE 100
Practice Address - Street 2:
Practice Address - City:COPPELL
Practice Address - State:TX
Practice Address - Zip Code:75019-4474
Practice Address - Country:US
Practice Address - Phone:972-712-3131
Practice Address - Fax:972-712-7171
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME99449207N00000X
VA0101236325207N00000X
TXP3869207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology