Provider Demographics
NPI:1689709206
Name:CHUNG, LADONNA (MD)
Entity Type:Individual
Prefix:DR
First Name:LADONNA
Middle Name:
Last Name:CHUNG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:LADONNA
Other - Middle Name:
Other - Last Name:SIMONEAU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:P.O. BOX 17624
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96817
Mailing Address - Country:US
Mailing Address - Phone:808-547-9548
Mailing Address - Fax:808-547-9718
Practice Address - Street 1:347 N KUAKINI ST
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817-2336
Practice Address - Country:US
Practice Address - Phone:808-547-9548
Practice Address - Fax:808-547-9718
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2014-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD 156712085R0001X
HI156712085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
H104570Medicare PIN
CT4053310Medicare ID - Type Unspecified
CTF01689Medicare UPIN