Provider Demographics
NPI:1528030525
Name:CHUNG, EUGENE P (MD)
Entity Type:Individual
Prefix:
First Name:EUGENE
Middle Name:P
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 1:17310 WRIGHT ST STE 103
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68130-2405
Mailing Address - Country:US
Mailing Address - Phone:833-228-6889
Mailing Address - Fax:877-853-0376
Practice Address - Street 1:17310 WRIGHT ST STE 103
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68130-2405
Practice Address - Country:US
Practice Address - Phone:833-228-6889
Practice Address - Fax:877-853-0376
Is Sole Proprietor?:No
Enumeration Date:2006-02-03
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND162722085R0202X
AZ336982085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0221810OtherBLUE CROSS BLUE SHIELD AZ
AZ920282Medicaid
AZ1Z7086OtherHEALTH NET OF ARIZONA
AZ1Z7086OtherHEALTH NET OF ARIZONA
I09473Medicare UPIN
AZ920282Medicaid
AZZ101969Medicare PIN
AZP00233301Medicare PIN
AZZ121144Medicare PIN
AZZ101970Medicare PIN
AZAZ0221810OtherBLUE CROSS BLUE SHIELD AZ