Healthcare Provider Details

I. General information

NPI: 1073505681
Provider Name (Legal Business Name): MAURICE K CHUNG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2005
Last Update Date: 01/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 S CABLE RD
LIMA OH
45805-3110
US

IV. Provider business mailing address

310 S CABLE RD
LIMA OH
45805-3110
US

V. Phone/Fax

Practice location:
  • Phone: 419-228-1000
  • Fax: 419-227-3085
Mailing address:
  • Phone: 419-228-1000
  • Fax: 419-227-3085

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number35058390
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License Number000330743I
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: