1922528504 NPI number — ERIN A CHUNG DO

Table of content: ERIN A CHUNG DO (NPI 1922528504)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922528504 NPI number — ERIN A CHUNG DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHUNG
Provider First Name:
ERIN
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DO
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1922528504
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/05/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3170 KETTERING BLVD BLDG B3
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MORAINE
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45439-1924
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
937-991-3188
Provider Business Mailing Address Fax Number:
937-223-9811

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1050 REID PARKWAY, SUITE 300
Provider Second Line Business Practice Location Address:
REID HOSPITAL FAMILY MEDICINE RESIDENCY
Provider Business Practice Location Address City Name:
RICHMOND
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47374
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
765-966-9549
Provider Business Practice Location Address Fax Number:
765-962-6268
Provider Enumeration Date:
06/23/2017

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 390200000X , with the licence number:  11019403A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: 34.014241 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0408209 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com