Basic Information
| Provider Information | |||||||||
| NPI: | 1528083516 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHUNG | ||||||||
| FirstName: | TAESUN | ||||||||
| MiddleName: | P | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2800 MAIN ST | ||||||||
| Address2: | ST.VINCENT'S MULTISPECIALTY GROUP | ||||||||
| City: | BRIDGEPORT | ||||||||
| State: | CT | ||||||||
| PostalCode: | 066064201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2035765346 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2000 POST RD | ||||||||
| Address2: | SUITE 305 | ||||||||
| City: | FAIRFIELD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 068245730 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2032543242 | ||||||||
| FaxNumber: | 2032543664 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/12/2006 | ||||||||
| LastUpdateDate: | 10/02/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 033428 | CT | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 0V7442 | 01 | CT | PHS | OTHER | 001334284 | 05 | CT | MEDICAID | ZP245 | 01 | CT | OXFORD | OTHER | 00133428403 | 01 | CT | BLUE CARE | OTHER | 171024 | 01 | CT | PREF ONE | OTHER | 746514 | 01 | CT | CTCARE | OTHER | 00133428CT06 | 01 | CT | ANTHEM | OTHER | 061610160 | 01 | CT | COM HEALTH | OTHER | 2508643 | 01 | CT | AETNA | OTHER |