Provider Demographics
NPI:1336364306
Name:CHUNG, MICHAEL BYUNGHAK (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:BYUNGHAK
Last Name:CHUNG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5810 S 300 E
Mailing Address - Street 2:#300
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84107
Mailing Address - Country:US
Mailing Address - Phone:801-314-2308
Mailing Address - Fax:801-314-2413
Practice Address - Street 1:5810 S 300 E
Practice Address - Street 2:#300
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107
Practice Address - Country:US
Practice Address - Phone:801-314-2308
Practice Address - Fax:801-314-2413
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT3323301205208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT3323301205OtherPHYSICIAN SURGEON