Provider Demographics
NPI:1740232917
Name:CHOUNG, WALTER I (MD)
Entity Type:Individual
Prefix:DR
First Name:WALTER
Middle Name:I
Last Name:CHOUNG
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 640580
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:FL
Mailing Address - Zip Code:34465-0580
Mailing Address - Country:US
Mailing Address - Phone:352-746-5707
Mailing Address - Fax:352-746-5944
Practice Address - Street 1:2155 W MUSTANG BLVD
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:FL
Practice Address - Zip Code:34465-0580
Practice Address - Country:US
Practice Address - Phone:352-746-5707
Practice Address - Fax:352-746-5944
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2010-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0066779207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL376362500Medicaid
FLE73220Medicare UPIN
FLK2586Medicare PIN
FL25624ZMedicare ID - Type Unspecified