Provider Demographics
NPI:1174382089
Name:YOUNG, CHUM LEN
Entity type:Individual
Prefix:
First Name:CHUM
Middle Name:LEN
Last Name:YOUNG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4900 US HIGHWAY 9
Mailing Address - Street 2:
Mailing Address - City:HOWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07731-3724
Mailing Address - Country:US
Mailing Address - Phone:732-905-0766
Mailing Address - Fax:732-905-8725
Practice Address - Street 1:4900 US HIGHWAY 9
Practice Address - Street 2:
Practice Address - City:HOWELL
Practice Address - State:NJ
Practice Address - Zip Code:07731-3724
Practice Address - Country:US
Practice Address - Phone:732-905-0766
Practice Address - Fax:732-905-8725
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-14
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJTD0001661156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician