Basic Information
| Provider Information | |||||||||
| NPI: | 1427257823 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHUNG | ||||||||
| FirstName: | ERIC EUI-SUN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2003 CENTRE POINTE BLVD | ||||||||
| Address2: | |||||||||
| City: | TALLAHASSEE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 323084893 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8508782273 | ||||||||
| FaxNumber: | 8506715900 | ||||||||
| Practice Location | |||||||||
| Address1: | 2003 CENTRE POINTE BLVD | ||||||||
| Address2: | |||||||||
| City: | TALLAHASSEE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 323084893 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8508782273 | ||||||||
| FaxNumber: | 8506715900 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/16/2007 | ||||||||
| LastUpdateDate: | 10/12/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | ME99517 | FL | N | Allopathic & Osteopathic Physicians | Internal Medicine | 2085R0001X | ME99517 | FL | Y | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology | 2085R0001X | N9188 | TX | N | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology |
ID Information
| ID | Type | State | Issuer | Description | 760528826 | 01 | TX | TAX ID | OTHER | 208302492 | 01 | TX | TAX ID | OTHER | 270573017 | 01 | TX | TAX ID | OTHER | 760567660 | 01 | TX | TAX ID | OTHER |