Provider Demographics
NPI:1487737193
Name:CHUNG, UEI K (MD)
Entity type:Individual
Prefix:
First Name:UEI
Middle Name:K
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 1:975 INMAN AVE
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820-1141
Mailing Address - Country:US
Mailing Address - Phone:908-561-0022
Mailing Address - Fax:908-561-0054
Practice Address - Street 1:975 INMAN AVE
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08820
Practice Address - Country:US
Practice Address - Phone:908-561-0022
Practice Address - Fax:908-561-0054
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03161500251X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251X00000XAgenciesSupports Brokerage
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ452136Medicare ID - Type Unspecified
NJD18972Medicare UPIN