Provider Demographics
NPI:1548356454
Name:CHU, TUNG TAMMY (MD)
Entity type:Individual
Prefix:
First Name:TUNG
Middle Name:TAMMY
Last Name:CHU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13360 41ST AVE FL 3
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-5811
Mailing Address - Country:US
Mailing Address - Phone:718-886-8830
Mailing Address - Fax:718-886-8825
Practice Address - Street 1:13360 41ST AVE FL 3
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-5811
Practice Address - Country:US
Practice Address - Phone:718-886-8830
Practice Address - Fax:718-886-8825
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY211188207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02063789Medicaid
NY5666435OtherFIRST HEALTH
NY7150121OtherAETNA PPO
NY23672OtherHIP
NY107851OtherGHI HMO
NY0498119OtherGHI
NY500B31OtherEMPIRE BLUE CROSS
NY1065899OtherAETNA HMO
NY4330818OtherCIGNA
NYP2208239OtherOXFORD
NY3C7946OtherHEALTH NET
NY8H1762Medicare ID - Type Unspecified
NY07041GMedicare ID - Type UnspecifiedGHI MEDICARE
NYH16074Medicare UPIN