Provider Demographics
NPI:1417066747
Name:CHUNG, PHILIP W (MD)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:W
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:PO BOX 1266
Mailing Address - Street 2:
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-1266
Mailing Address - Country:US
Mailing Address - Phone:808-261-3326
Mailing Address - Fax:808-262-0514
Practice Address - Street 1:407 ULUNIU ST
Practice Address - Street 2:4TH FLOOR
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734-2519
Practice Address - Country:US
Practice Address - Phone:808-261-3326
Practice Address - Fax:808-262-0514
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD13606207P00000X
NMMD2005-0548207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI0000257964OtherHMSA
NM75920727Medicaid
HI576978Medicaid
HIH101285Medicare PIN
HI576978Medicaid