Provider Demographics
NPI:1235194549
Name:CHUNG, KATHERINE D (MD)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:D
Last Name:CHUNG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:DONNA
Other - Last Name:CHUNG-BRIDGES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:3550 BISCAYNE BLVD
Mailing Address - Street 2:SUITE 600
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33137-3841
Mailing Address - Country:US
Mailing Address - Phone:786-431-1073
Mailing Address - Fax:305-456-3509
Practice Address - Street 1:3550 BISCAYNE BLVD
Practice Address - Street 2:SUITE 600
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33137-3841
Practice Address - Country:US
Practice Address - Phone:786-431-1073
Practice Address - Fax:305-456-3509
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-19
Last Update Date:2011-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME91328207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL271200800Medicaid
FL271200800Medicaid