1386641546 NPI number — CHAY UNG MD

Table of content: CHAY UNG MD (NPI 1386641546)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386641546 NPI number — CHAY UNG MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
UNG
Provider First Name:
CHAY
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1386641546
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/27/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12234 SHADOW CREEK PKWY
Provider Second Line Business Mailing Address:
STE 8110
Provider Business Mailing Address City Name:
PEARLAND
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77584-7341
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-997-1261
Provider Business Mailing Address Fax Number:
281-997-1271

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10970 SHADOW CREEK PKWY
Provider Second Line Business Practice Location Address:
SUITE 250
Provider Business Practice Location Address City Name:
PEARLAND
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77584-0100
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-436-9475
Provider Business Practice Location Address Fax Number:
713-436-9059
Provider Enumeration Date:
07/03/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  L8542 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 8U7692 . This is a "BCBS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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