Provider Demographics
NPI:1104981026
Name:CHUNG, RICHARD TAM (MD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:TAM
Last Name:CHUNG
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:PO BOX 246
Mailing Address - Street 2:
Mailing Address - City:BLUE SPRINGS
Mailing Address - State:MO
Mailing Address - Zip Code:64013-0246
Mailing Address - Country:US
Mailing Address - Phone:816-229-9411
Mailing Address - Fax:816-229-9411
Practice Address - Street 1:500 NW VESPER ST
Practice Address - Street 2:
Practice Address - City:BLUE SPRINGS
Practice Address - State:MO
Practice Address - Zip Code:64014-2744
Practice Address - Country:US
Practice Address - Phone:816-229-9411
Practice Address - Fax:816-229-9411
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-22
Last Update Date:2010-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO34226207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
025461OtherBCBS KS
111077615OtherMEDICARE RAILROAD
02067022OtherBCBS KC
MO200179109Medicaid
0003268Medicare ID - Type Unspecified
C52147Medicare UPIN