Healthcare Provider Details

I. General information

NPI: 1184537680
Provider Name (Legal Business Name): TAEKHWAN CHUNG MD, FRCSC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: DAVID CHUNG MD, FRCSC

II. Dates (important events)

Enumeration Date: 09/24/2026
Last Update Date: 10/11/2026
Certification Date: 10/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2050 E 96TH ST BLDG Q
CLEVELAND OH
44106-2970
US

IV. Provider business mailing address

2050 E 96TH ST BLDG Q
CLEVELAND OH
44106-2970
US

V. Phone/Fax

Practice location:
  • Phone: 216-372-6873
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: