Provider Demographics
NPI:1386876282
Name:CHUNG, DERRICK Y (OD)
Entity type:Individual
Prefix:
First Name:DERRICK
Middle Name:Y
Last Name:CHUNG
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1251
Mailing Address - Street 2:
Mailing Address - City:SAUGUS
Mailing Address - State:MA
Mailing Address - Zip Code:01906-0551
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:603-574-4839
Practice Address - Street 1:779 LAFAYETTE RD. UNIT 5
Practice Address - Street 2:
Practice Address - City:SEABROOK
Practice Address - State:NH
Practice Address - Zip Code:03874-4351
Practice Address - Country:US
Practice Address - Phone:603-474-3781
Practice Address - Fax:603-574-4839
Is Sole Proprietor?:No
Enumeration Date:2009-08-12
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4758152W00000X
IA123639126900000X
RIODTG00564152W00000X
NH0859152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No126900000XDental ProvidersDental Laboratory Technician