Provider Demographics
NPI:1871605782
Name:CHUNG, HEATH H (MD)
Entity type:Individual
Prefix:
First Name:HEATH
Middle Name:H
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 37056
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96837-0056
Mailing Address - Country:US
Mailing Address - Phone:808-228-5436
Mailing Address - Fax:
Practice Address - Street 1:1329 LUSITANA ST
Practice Address - Street 2:SUITE 804
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-2429
Practice Address - Country:US
Practice Address - Phone:808-531-7111
Practice Address - Fax:808-528-5507
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2021-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI13906207R00000X, 207RI0200X
MN49951207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN213643000Medicaid
MNP00427423OtherRAILROAD MEDICARE
HI58517701Medicaid
MN440000255Medicare PIN