Provider Demographics
NPI:1962572339
Name:CHUNG, HOSUNG (MD)
Entity type:Individual
Prefix:DR
First Name:HOSUNG
Middle Name:
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 1:1762 CARAS RD
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50701-9793
Mailing Address - Country:US
Mailing Address - Phone:319-233-9567
Mailing Address - Fax:319-233-3061
Practice Address - Street 1:1762 CARAS RD
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50701-9793
Practice Address - Country:US
Practice Address - Phone:319-233-9567
Practice Address - Fax:319-233-3061
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA20569207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAA01235Medicare UPIN