Provider Demographics
NPI:1154546752
Name:CHA, KYUNG SOO (MD)
Entity type:Individual
Prefix:MR
First Name:KYUNG
Middle Name:SOO
Last Name:CHA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:38 WEST 32ND STREET
Mailing Address - Street 2:#601
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001
Mailing Address - Country:US
Mailing Address - Phone:212-714-0014
Mailing Address - Fax:212-714-1010
Practice Address - Street 1:38 WEST 32ND STREET
Practice Address - Street 2:#601
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001
Practice Address - Country:US
Practice Address - Phone:212-714-0014
Practice Address - Fax:212-714-1010
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY149923207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00829089Medicaid