Provider Demographics
NPI:1962440164
Name:CHUNG, CALEB YOUNG-JU (DPM)
Entity type:Individual
Prefix:DR
First Name:CALEB
Middle Name:YOUNG-JU
Last Name:CHUNG
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:570 MAIN ST STE 101
Mailing Address - Street 2:
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024-5058
Mailing Address - Country:US
Mailing Address - Phone:201-363-1200
Mailing Address - Fax:201-363-1600
Practice Address - Street 1:570 MAIN ST STE 101
Practice Address - Street 2:
Practice Address - City:FORT LEE
Practice Address - State:NJ
Practice Address - Zip Code:07024-5058
Practice Address - Country:US
Practice Address - Phone:201-363-1200
Practice Address - Fax:201-363-1600
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2022-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00263100213EP1101X, 213ER0200X, 213ES0131X, 213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
No213ER0200XPodiatric Medicine & Surgery Service ProvidersPodiatristRadiology
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1953226OtherFIRST HEALTH
NJ38688OtherMASTERCARE
NJ2289032OtherUNITEDHEALTH PLAN
NJ8891202002OtherCIGNA
NJPG6032OtherWELL CHOICE
NJ1147720OtherHORIZON NJ HEALTH
NJ1K8521OtherHEALTHNET
NJ2106180000OtherAMERIHEALTH
NJ33046OtherUNIVERSITY HEALTH PLAN
NJ967806OtherONE HEALTH PLAN
NJ51508OtherAMERIGROUP
NJ85344OtherOPERATING ENG LOCAL 825
NJ8569207Medicaid
NJP2525266OtherOXFORD
NJ8569207Medicaid
NJ85344OtherOPERATING ENG LOCAL 825
NJ8891202002OtherCIGNA