Healthcare Provider Details

I. General information

NPI: 1609981216
Provider Name (Legal Business Name): ERIC Y CHUNG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 11/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 PUNCHBOWL ST
HONOLULU HI
96813-2402
US

IV. Provider business mailing address

PO BOX 26345
HONOLULU HI
96825-6345
US

V. Phone/Fax

Practice location:
  • Phone: 808-395-8383
  • Fax: 808-395-0143
Mailing address:
  • Phone: 808-395-8383
  • Fax: 808-395-0143

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License NumberMD-6062
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: