Provider Demographics
NPI:1386923910
Name:FOK, CHI CHUNG VICTOR (PHD)
Entity type:Individual
Prefix:DR
First Name:CHI CHUNG
Middle Name:VICTOR
Last Name:FOK
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:CHI
Other - Middle Name:VICTOR
Other - Last Name:FOK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:15 SQUIRE LN
Mailing Address - Street 2:
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06518-1417
Mailing Address - Country:US
Mailing Address - Phone:203-887-4267
Mailing Address - Fax:
Practice Address - Street 1:1300 WHALLEY AVE
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06515-1101
Practice Address - Country:US
Practice Address - Phone:203-891-7031
Practice Address - Fax:203-891-7537
Is Sole Proprietor?:No
Enumeration Date:2011-08-14
Last Update Date:2022-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTPCT.0010965183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist