Basic Information
| Provider Information | |||||||||
| NPI: | 1003893926 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHUNG | ||||||||
| FirstName: | EUGENE | ||||||||
| MiddleName: | |||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 237 WILLIAM HOWARD TAFT RD | ||||||||
| Address2: | 2ND FLOOR, CBO 2-3 | ||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452192610 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5132061180 | ||||||||
| FaxNumber: | 5132061183 | ||||||||
| Practice Location | |||||||||
| Address1: | 2123 AUBURN AVE | ||||||||
| Address2: | SU. 137 | ||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452192906 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5132061180 | ||||||||
| FaxNumber: | 5132061183 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/30/2005 | ||||||||
| LastUpdateDate: | 10/24/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/24/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | 35078012 | OH | N | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | 207RA0001X | 35078012 | OH | Y |
ID Information
| ID | Type | State | Issuer | Description | 25-00402 | 01 | OH | UNITED | OTHER | 2330805 | 01 | OH | AETNA | OTHER | 283775 | 01 | CARESOURE MEDICAID OH | OTHER | 283775 | 01 | AMERIGROUP OH MEDICAID | OTHER | 200329880 | 05 | IN | MEDICAID | 2226960 | 05 | OH | MEDICAID | 28444429001 | 01 | OH | MEDICAL MUTUAL | OTHER | 000000077109 | 01 | OH | ANTHEM | OTHER | 64031149 | 05 | KY | MEDICAID | 78012-01 | 01 | HUMANA | OTHER | 060059827 | 01 | RAILROAD | OTHER |