Provider Demographics
NPI:1164954608
Name:HEATH H. CHUNG, MD LLC
Entity Type:Organization
Organization Name:HEATH H. CHUNG, MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:TANYA
Authorized Official - Middle Name:
Authorized Official - Last Name:FLORIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-228-5436
Mailing Address - Street 1:PO BOX 37056
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96837-0056
Mailing Address - Country:US
Mailing Address - Phone:808-228-5436
Mailing Address - Fax:808-528-5507
Practice Address - Street 1:500 ALA MOANA BLVD
Practice Address - Street 2:5-300
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-4920
Practice Address - Country:US
Practice Address - Phone:808-531-7111
Practice Address - Fax:808-528-5507
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-03
Last Update Date:2017-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI585177Medicaid
HI585177Medicaid