Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VF0040X | Female Pelvic Medicine and Reconstructive Surgeon | 000330743I | OH |
N | 207VG0400X | Gynecologist | 35058390 | OH |
NPI | 1073505681 |
---|---|
Provider Name | Dr. Maurice K Chung |
First Address | Lima, OH 45805-3110 |
Second Address | Lima, OH 45805-3110 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/08/2005 |
Last Update Date | 25/01/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0742307 | (05) | OH |
160019139 | RR MEDICARE (01) | OH |
29189 | ANTHEM (01) | OH |
E57707 | (02) | OH |
P01387049 | MEDICARE PTAN (01) | OH |