1841399615 NPI number — DR. SUSAN CHUNG M.D.

Table of content: DR. SUSAN CHUNG M.D. (NPI 1841399615)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841399615 NPI number — DR. SUSAN CHUNG M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHUNG
Provider First Name:
SUSAN
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SOHN
Provider Other First Name:
SUSAN
Provider Other Middle Name:
HI
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1841399615
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/03/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6301 S MCCLINTOCK DR
Provider Second Line Business Mailing Address:
#101
Provider Business Mailing Address City Name:
TEMPE
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85283-3392
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-214-2300
Provider Business Mailing Address Fax Number:
480-214-2301

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
60 S KYRENE RD
Provider Second Line Business Practice Location Address:
#1
Provider Business Practice Location Address City Name:
CHANDLER
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85226-4685
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-785-8700
Provider Business Practice Location Address Fax Number:
480-785-8787
Provider Enumeration Date:
09/21/2006

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: 208000000X , with the licence number:  30500 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 00014245 . This is a "BANNER HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1Z65553 . This is a "HEALTHNET" identifier . This identifiers is of the category "OTHER".
  • Identifier: 713439 . This is a "AHCCCS" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 7134390 . This is a "DES" identifier . This identifiers is of the category "OTHER".
  • Identifier: 713439001 . This is a "APIPA" identifier . This identifiers is of the category "OTHER".
  • Identifier: AZ0719840 . This is a "BLUE CROSS BLUE SHIELD" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com