Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208800000X | Urologist | 25MA10273100 | NJ |
Y | 208800000X | Urologist | MD460767 | PA |
NPI | 1063702702 |
---|---|
Provider Name | Paul Hwan Chung |
First Address | Philadelphia, PA 19107-4409 |
Second Address | Philadelphia, PA 19107-4409 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/04/2011 |
Last Update Date | 05/02/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
103349031 | (05) | PA |
674133 | (05) | NJ |