Provider Demographics
NPI:1679735724
Name:CHUNG, GRACE (MD)
Entity type:Individual
Prefix:DR
First Name:GRACE
Middle Name:
Last Name:CHUNG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:40 RESEARCH WAY
Mailing Address - Street 2:SUITE 105
Mailing Address - City:EAST SETAUKET
Mailing Address - State:NY
Mailing Address - Zip Code:11733-3523
Mailing Address - Country:US
Mailing Address - Phone:631-872-8279
Mailing Address - Fax:
Practice Address - Street 1:1320 STONY BROOK ROAD
Practice Address - Street 2:BUILDING D, SUITE 100
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11790
Practice Address - Country:US
Practice Address - Phone:631-941-2273
Practice Address - Fax:631-941-2501
Is Sole Proprietor?:No
Enumeration Date:2008-06-30
Last Update Date:2022-05-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY273197-1207RC0000X, 207R00000X
IL125054265207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease