Provider Demographics
NPI:1861597932
Name:CHUNG, CRAWFORD (MD)
Entity type:Individual
Prefix:
First Name:CRAWFORD
Middle Name:
Last Name:CHUNG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3838 CALIFORNIA ST
Mailing Address - Street 2:SUITE 508
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94118-1522
Mailing Address - Country:US
Mailing Address - Phone:415-831-9788
Mailing Address - Fax:415-751-6158
Practice Address - Street 1:3838 CALIFORNIA ST
Practice Address - Street 2:SUITE 508
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94118-1522
Practice Address - Country:US
Practice Address - Phone:415-831-9788
Practice Address - Fax:415-751-6158
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2010-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA30305207R00000X, 207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A303051Medicaid
CAA26045Medicare UPIN
CA00A303051Medicare ID - Type Unspecified