Provider Demographics
NPI:1245220581
Name:CHUNG, KWANG HO (MD)
Entity Type:Individual
Prefix:DR
First Name:KWANG
Middle Name:HO
Last Name:CHUNG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:835 HOSPITAL ROAD
Mailing Address - Street 2:PO BOX 788
Mailing Address - City:INDIANA
Mailing Address - State:PA
Mailing Address - Zip Code:15701-0788
Mailing Address - Country:US
Mailing Address - Phone:724-357-7009
Mailing Address - Fax:724-357-7414
Practice Address - Street 1:835 HOSPITAL ROAD
Practice Address - Street 2:EMERGENCY DEPARTMENT
Practice Address - City:INDIANA
Practice Address - State:PA
Practice Address - Zip Code:15701-0788
Practice Address - Country:US
Practice Address - Phone:724-357-7121
Practice Address - Fax:724-357-7479
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD026062E207P00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA251898OtherUPMC
PA0009409450004Medicaid
PAC27777Medicare UPIN
PA0009409450004Medicaid