Provider Demographics
NPI:1528083516
Name:CHUNG, TAESUN P (MD)
Entity type:Individual
Prefix:
First Name:TAESUN
Middle Name:P
Last Name:CHUNG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2800 MAIN ST
Mailing Address - Street 2:ST.VINCENT'S MULTISPECIALTY GROUP
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06606-4201
Mailing Address - Country:US
Mailing Address - Phone:203-576-5346
Mailing Address - Fax:
Practice Address - Street 1:2000 POST RD
Practice Address - Street 2:SUITE 305
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06824-5730
Practice Address - Country:US
Practice Address - Phone:203-254-3242
Practice Address - Fax:203-254-3664
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2014-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT033428208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT0V7442OtherPHS
CT001334284Medicaid
CTZP245OtherOXFORD
CT00133428403OtherBLUE CARE
CT171024OtherPREF ONE
CT746514OtherCTCARE
CT00133428CT06OtherANTHEM
CT061610160OtherCOM HEALTH
CT2508643OtherAETNA
CT00133428403OtherBLUE CARE