Provider Demographics
NPI:1952322703
Name:CHUNG, TAE HONG (MD)
Entity Type:Individual
Prefix:DR
First Name:TAE
Middle Name:HONG
Last Name:CHUNG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
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 ROAD
Practice Address - Street 2:BOX 406
Practice Address - City:ALGONAC
Practice Address - State:MI
Practice Address - Zip Code:48001
Practice Address - Country:US
Practice Address - Phone:810-794-9324
Practice Address - Fax:810-794-0705
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MITC035184207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine