Provider Demographics
NPI:1417299348
Name:CHUNG, ANNISE KIEU (DO)
Entity type:Individual
Prefix:
First Name:ANNISE
Middle Name:KIEU
Last Name:CHUNG
Suffix:
Gender:
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3158 FREEDOM DR STE 3102
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28208-0014
Mailing Address - Country:US
Mailing Address - Phone:704-971-7099
Mailing Address - Fax:704-971-0035
Practice Address - Street 1:3158 FREEDOM DR STE 3101
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28208-0014
Practice Address - Country:US
Practice Address - Phone:704-348-2992
Practice Address - Fax:704-334-3061
Is Sole Proprietor?:No
Enumeration Date:2013-03-18
Last Update Date:2025-05-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC2023-00627208M00000X, 207RN0300X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine