Provider Demographics
NPI:1124043013
Name:ERNEST CHUNG MD & ASSOCIATES PA
Entity Type:Organization
Organization Name:ERNEST CHUNG MD & ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ERNEST
Authorized Official - Middle Name:
Authorized Official - Last Name:CHUNG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-892-5856
Mailing Address - Street 1:2920 17TH ST
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:FL
Mailing Address - Zip Code:34769-6018
Mailing Address - Country:US
Mailing Address - Phone:407-892-5856
Mailing Address - Fax:407-892-5885
Practice Address - Street 1:2920 17TH ST
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:FL
Practice Address - Zip Code:34769-6018
Practice Address - Country:US
Practice Address - Phone:407-892-5856
Practice Address - Fax:407-892-5885
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-13
Last Update Date:2010-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME83366261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL262909700Medicaid
FL262909700Medicaid
FLG41881Medicare UPIN