Provider Demographics
NPI:1588747935
Name:CHUNG, DEREK GEORGE (MD)
Entity type:Individual
Prefix:DR
First Name:DEREK
Middle Name:GEORGE
Last Name:CHUNG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1347 E 89TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11236-5121
Mailing Address - Country:US
Mailing Address - Phone:718-258-3085
Mailing Address - Fax:718-258-2039
Practice Address - Street 1:2244 CHURCH AVE FL 3
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11226-4195
Practice Address - Country:US
Practice Address - Phone:718-352-0083
Practice Address - Fax:718-627-1525
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-21
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY192240207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY5100205OtherGHI
NY2Y8963OtherEMPIRE BC/BS
NY1903280OtherUNITED HEALTHCARE
NY02020639Medicaid
NYP1883718OtherOXFORD
NY1903280OtherUNITED HEALTHCARE
NY2Y8962Medicare ID - Type Unspecified