Provider Demographics
NPI:1720158066
Name:CHUNG, CHI FEI (MD)
Entity Type:Individual
Prefix:DR
First Name:CHI FEI
Middle Name:
Last Name:CHUNG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:KEITH
Other - Middle Name:
Other - Last Name:CHUNG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:4150 NELSON RD STE B6
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70605-4169
Mailing Address - Country:US
Mailing Address - Phone:337-433-1303
Mailing Address - Fax:337-433-4644
Practice Address - Street 1:4150 NELSON RD STE B6
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70605-4169
Practice Address - Country:US
Practice Address - Phone:337-433-1303
Practice Address - Fax:337-433-4644
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2017-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA022117208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1496391Medicaid
LA5Y814Medicare ID - Type Unspecified
LA1496391Medicaid