Provider Demographics
NPI:1861452948
Name:CHUNG, MATTHEW (MD)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
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 26010
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44319-6010
Mailing Address - Country:US
Mailing Address - Phone:888-328-4534
Mailing Address - Fax:
Practice Address - Street 1:1232 BUCHHOLZER BLVD
Practice Address - Street 2:
Practice Address - City:CUYAHOGA FALLS
Practice Address - State:OH
Practice Address - Zip Code:44221-5179
Practice Address - Country:US
Practice Address - Phone:330-928-8700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2011-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-058849C207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH107OtherSUMMACARE
OH000000132168OtherANTHEM
OH100606OtherKAISER
OH729742OtherBUCKEYE COMMUNITY HEALTH
OH0851574Medicaid
OH0403135OtherUNITED HEALTHCARE
OH047583OtherSELECT CARE
OH110178136OtherRAILROAD MEDICARE
OH341458069046OtherCARESOURCE
OH110178136OtherRAILROAD MEDICARE
OH107OtherSUMMACARE