Provider Demographics
NPI:1225423254
Name:CHUNG, SO (MD,)
Entity type:Individual
Prefix:DR
First Name:SO
Middle Name:
Last Name:CHUNG
Suffix:
Gender:
Credentials:MD,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6750 TRYON RD STE 101
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27518-7056
Mailing Address - Country:US
Mailing Address - Phone:919-338-0650
Mailing Address - Fax:919-335-9087
Practice Address - Street 1:6750 TRYON RD STE 101
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27518-7056
Practice Address - Country:US
Practice Address - Phone:919-342-6400
Practice Address - Fax:919-335-9087
Is Sole Proprietor?:No
Enumeration Date:2015-04-06
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2021-01987207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine