KEUN SAM CHUNG MD (Credential# 542898) is licensed (Physician/surgeon) with Connecticut Department of Consumer Protection. The license effective date is November 1, 2019. The license expiration date date is October 31, 2020. The license status is ACTIVE.
KEUN SAM CHUNG MD is licensed with the Department of Consumer Protection of Connecticut. The credential number is #1.018808. The credential type is physician/surgeon. The effective date is November 1, 2019. The expiration date is October 31, 2020. The business address is 15 Grouse Lane, Woodbridge, CT 06525. The current status is active.
| Licensee Name | KEUN SAM CHUNG MD |
| Credential ID | 542898 |
| Credential Number | 1.018808 |
| Credential Type | Physician/Surgeon |
| Business Address |
15 Grouse Lane Woodbridge CT 06525 |
| Business Type | INDIVIDUAL |
| Status | ACTIVE - CURRENT |
| Active | 1 |
| Issue Date | 1977-05-31 |
| Effective Date | 2019-11-01 |
| Expiration Date | 2020-10-31 |
| Refresh Date | 2019-11-21 |
| ID | Credential Code | Credential Type | Issue | Term | Status |
|---|---|---|---|---|---|
| 153718 | CSP.0004413 | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER | 1999-03-01 | 2017-03-01 - 2019-02-28 | LAPSED |
| Street Address | 15 GROUSE LANE |
| City | WOODBRIDGE |
| State | CT |
| Zip Code | 06525 |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Hyue Kyung Choi | 11 Rock Hill Road, Woodbridge, CT 06525 | Combination Nail Technician, Esthetician Or Eyelash Technici | ~ |
| Jewish Cemetery Association of Greater New Haven | 360 Amity Road, Woodbridge, CT 06525 | Public Charity | 2020-07-01 ~ 2021-06-30 |
| Nancy Bradstreet | 146 Northrop Rd., Woodbridge, CT 06525 | Licensed Clinical Social Worker | 2020-09-01 ~ 2021-08-31 |
| Robert I Tucker | 15 Research Drive, Woodbridge, CT 06525 | Architect | 2020-08-01 ~ 2021-07-31 |
| Amity Brick Oven Pizza Inc · Joseph R Sarno | 142 Amity Rd, New Haven, CT 06525 | Bakery | 2020-07-01 ~ 2021-06-30 |
| Linda A Starace-colabella | 895 Baldwin Rd, Woodbridge, CT 06525 | Physician/surgeon | 2020-08-01 ~ 2021-07-31 |
| Patricia A Kenyon · Leskow | 8 Maple Terrace, Woodbridge, CT 06525 | Registered Nurse | 2020-09-01 ~ 2021-08-31 |
| Marianne L Dexter | 37 Acorn Hill Rd, Woodbridge, CT 06525 | Registered Nurse | 2020-08-01 ~ 2021-07-31 |
| Debra G Wayne | 94 Maple Vale Drive, Woodbridge, CT 06525 | Psychologist | 2020-09-01 ~ 2021-08-31 |
| Timothy Michael Carney | 1119 Racebrook Road, Woodbridge, CT 06525 | Emergency Medical Technician | 2016-08-19 ~ 2020-03-31 |
| Find all Licenses in zip 06525 | |||
| City | WOODBRIDGE |
| Zip Code | 06525 |
| License Type | Physician/Surgeon |
| License Type + County | Physician/Surgeon + WOODBRIDGE |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Keun Soo Chung | 59-66 61st Street, Maspeth, NY 11378 | Asbestos Abatement Worker | 2002-01-30 ~ 2002-12-31 |
| Jin H Chung | 211 Maple Dr, Coventry, CT 06238-2833 | Physician/surgeon | 2019-12-01 ~ 2020-11-30 |
| Sun M Chung | 315 E 70th St Apt 11r, New York, NY 10021-8651 | Physician/surgeon | 2019-07-01 ~ 2020-06-30 |
| Kyung H Chung | Boston, MA 02111 | Physician/surgeon | 2020-05-01 ~ 2021-04-30 |
| Eui K Chung Md | 255 Pomfret St, Putnam, CT 06260 | Physician/surgeon | 2006-03-22 ~ 2007-05-31 |
| Nancy Chung | 73 Market St Ste 219, Yonkers, NY 10710-7617 | Physician/surgeon | 2020-07-01 ~ 2021-06-30 |
| Hannah Chung | 540 Litchfield St., Torrington, CT 06790 | Physician/surgeon | 2016-03-28 ~ 2017-02-28 |
| James B Chung | Pfizer, Inc., Groton, CT 06340 | Physician/surgeon | 2003-06-05 ~ 2004-07-31 |
| Sulin Chung | 532 Route 9w, Piermont, NY 10968 | Physician/surgeon | 2019-12-01 ~ 2020-11-30 |
| Chung K Shin | 91 East Ave, Norwalk, CT 06851 | Physician/surgeon | 2020-05-01 ~ 2021-04-30 |
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| Data Provider | Connecticut Department of Consumer Protection |
| Jurisdiction | Connecticut |
| Related Datasets | Connecticut Business Registrations, Connecticut Child Care Facilities |
This dataset includes 1.41 million licenses issued wtih Connecticut Department of Consumer Protection (TDLR).