Provider Demographics
NPI:1871521708
Name:CHUNG, SOOYOUNG PETER (MD)
Entity type:Individual
Prefix:
First Name:SOOYOUNG
Middle Name:PETER
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 1:1720 SE 16TH AVE STE 303
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-4620
Mailing Address - Country:US
Mailing Address - Phone:352-369-0288
Mailing Address - Fax:352-867-1053
Practice Address - Street 1:1720 SE 16TH AVE STE 303
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-4620
Practice Address - Country:US
Practice Address - Phone:352-369-0288
Practice Address - Fax:352-867-1053
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2018-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME59509208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL12456OtherBCBS FL
FL059341900Medicaid
FLE95736Medicare UPIN
FL059341900Medicaid
FL780001922Medicare PIN
FL12456ZMedicare PIN
FL12456YMedicare PIN
FL12456OtherBCBS FL