Provider Demographics
NPI:1487842142
Name:TAE HONG CHUNG, MD, PC
Entity Type:Organization
Organization Name:TAE HONG CHUNG, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TAE
Authorized Official - Middle Name:HONG
Authorized Official - Last Name:CHUNG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:810-794-9324
Mailing Address - Street 1:2700 POINTE TREMBLE RD
Mailing Address - Street 2:
Mailing Address - City:ALGONAC
Mailing Address - State:MI
Mailing Address - Zip Code:48001-1836
Mailing Address - Country:US
Mailing Address - Phone:810-794-9324
Mailing Address - Fax:810-794-0705
Practice Address - Street 1:2700 POINTE TREMBLE RD
Practice Address - Street 2:
Practice Address - City:ALGONAC
Practice Address - State:MI
Practice Address - Zip Code:48001-1836
Practice Address - Country:US
Practice Address - Phone:810-794-9324
Practice Address - Fax:810-794-0705
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-09
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MITC035184261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2104149Medicaid
MI2104149Medicaid