Provider Demographics
NPI:1932187416
Name:CHUNG, JOSEPH KISE (MD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:KISE
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 1:3116 MYRTICE DR
Mailing Address - Street 2:
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75022-0968
Mailing Address - Country:US
Mailing Address - Phone:708-359-2919
Mailing Address - Fax:
Practice Address - Street 1:1300 S FIELDER RD
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76013-2348
Practice Address - Country:US
Practice Address - Phone:817-277-2221
Practice Address - Fax:817-459-5253
Is Sole Proprietor?:No
Enumeration Date:2006-01-05
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036106892207Q00000X
TXU9493207Q00000X
NC2020-04159207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036106892-1Medicaid
IL04532170OtherBLUE CROSS BLUE SHIELD
ILH68843Medicare UPIN
IL208439001Medicare PIN
IL203568Medicare ID - Type Unspecified