Provider Demographics
NPI:1871653782
Name:HA, CHUNG KI (MD)
Entity type:Individual
Prefix:
First Name:CHUNG
Middle Name:KI
Last Name:HA
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 1:15615 35TH AVE
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-5015
Mailing Address - Country:US
Mailing Address - Phone:718-463-6134
Mailing Address - Fax:718-463-6275
Practice Address - Street 1:15615 35TH AVE
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-5015
Practice Address - Country:US
Practice Address - Phone:718-463-6134
Practice Address - Fax:718-463-6275
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY190445207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01727724Medicaid
NYG26704Medicare UPIN
NY0271IFMedicare ID - Type Unspecified