Provider Demographics
NPI:1215188214
Name:CHUNG, DOREEN E (MD)
Entity type:Individual
Prefix:
First Name:DOREEN
Middle Name:E
Last Name:CHUNG
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 LAKEVILLE RD STE M41
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11042-1117
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:450 LAKEVILLE RD STE M41
Practice Address - Street 2:
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11042-1117
Practice Address - Country:US
Practice Address - Phone:516-734-8500
Practice Address - Fax:516-734-8535
Is Sole Proprietor?:No
Enumeration Date:2008-10-08
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY277192208800000X, 2088F0040X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2088F0040XAllopathic & Osteopathic PhysiciansUrologyUrogynecology and Reconstructive Pelvic Surgery
No208800000XAllopathic & Osteopathic PhysiciansUrology