MEDICARE: DR. GWENDOLYN PATRICIA CHUNG M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	10217	HI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	B222436	OTHER		HMSA
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1043305543
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GWENDOLYN PATRICIA CHUNG M.D.

Provider Business Mailing Address
First Line	:	1441 KAPIOLANI BOULEVARD
Second Line	:	SUITE 1810
City	:	HONOLULU
State	:	HI
Zip	:	96814-4408
Country	:	US
Telephone Number	:	808-949-5308
Fax Number	:	808-943-0963

Provider Business Practice Location Address
First Line	:	1441 KAPIOLANI BOULEVARD
Second Line	:	SUITE 1810
City	:	HONOLULU
State	:	HI
Zip	:	96814-4408
Country	:	US
Telephone Number	:	808-949-5308
Fax Number	:	808-943-0963

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/03/2006
Last Update Date	:	11/06/2007

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