Provider Demographics
NPI:1306890298
Name:CHUNG, CHARLES R (MD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:R
Last Name:CHUNG
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1850 CENTRAL DR
Mailing Address - Street 2:#B
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76021-5821
Mailing Address - Country:US
Mailing Address - Phone:817-267-1521
Mailing Address - Fax:817-267-1523
Practice Address - Street 1:1850 CENTRAL DR
Practice Address - Street 2:#B
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76021-5821
Practice Address - Country:US
Practice Address - Phone:817-267-1521
Practice Address - Fax:817-267-1523
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2007-10-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXE3149207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00P347Medicare PIN
TXC14490Medicare UPIN