Provider Demographics
NPI:1306320734
Name:CHUNG, JEONGHA (PHARMD)
Entity type:Individual
Prefix:DR
First Name:JEONGHA
Middle Name:
Last Name:CHUNG
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:HEIDI
Other - Middle Name:
Other - Last Name:CHUNG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARMD
Mailing Address - Street 1:929 N BROADWAY
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80203-2705
Mailing Address - Country:US
Mailing Address - Phone:800-874-5881
Mailing Address - Fax:
Practice Address - Street 1:929 N BROADWAY
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80203-2705
Practice Address - Country:US
Practice Address - Phone:800-874-5881
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-21
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPHA.0022906183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
COPHA.0022906OtherCOLORADO DEPARTMENT OF REGULATORY AGENCIES
CO9000200388Medicaid