Provider Demographics
NPI:1487806030
Name:CHUNG, SOOK OK (AP, LAC, NCCAOM, DOM)
Entity type:Individual
Prefix:
First Name:SOOK
Middle Name:OK
Last Name:CHUNG
Suffix:
Gender:F
Credentials:AP, LAC, NCCAOM, DOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4707 EDGEWATER DRIVE
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32804
Mailing Address - Country:US
Mailing Address - Phone:407-521-5565
Mailing Address - Fax:407-521-5565
Practice Address - Street 1:4707 EDGEWATER DRIVE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804
Practice Address - Country:US
Practice Address - Phone:407-521-5565
Practice Address - Fax:407-521-5565
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-15
Last Update Date:2010-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP548171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL11996091OtherCIGNA
FL21193360572-01OtherBEECHSTREET
FL730451OtherRESERVE NATIONAL
FL730451OtherGREAT WEST HEALTHCARE
FL7425760OtherAETNA
FLC-0584OtherBLUECROSS BLUESHEILD
FL730451OtherMEDICAL RESOURCE, LLC
FL730451OtherPREMERA BLUE CROSS
FL730451OtherUNITED HEALTH CARE