Basic Information
Provider Information
NPI: 1215179122
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CHUN
FirstName: NICHOLAS
MiddleName: HO-YOUNG
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1 GUSTAVE L LEVY PL
Address2: BOX 3000
City: NEW YORK
State: NY
PostalCode: 100296504
CountryCode: US
TelephoneNumber: 2129873100
FaxNumber: 2127315210
Practice Location
Address1: 1 GUSTAVE L LEVY PL
Address2:  
City: NEW YORK
State: NY
PostalCode: 100296504
CountryCode: US
TelephoneNumber: 2122416609
FaxNumber: 2122418445
Other Information
ProviderEnumerationDate: 03/25/2009
LastUpdateDate: 04/03/2017
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
390200000X  N Student, Health CareStudent in an Organized Health Care Education/Training Program 
207RN0300X260677NYY Allopathic & Osteopathic PhysiciansInternal MedicineNephrology

No ID Information.


Home