Chung, Tai Jin

Chung, Tai Jin is an individual health care provider with primary practice located at 830 Oak St 125E, Brockton MA 02301-1168. He recently has only one registered license in Allopathic & Osteopathic Physicians / Nephrology, which is considered as his primary health care specialty. Chung, Tai Jin can be contacted via phone (508) 588-1505.

Contact Information

Primary practice address
830 Oak St 125E Brockton MA 02301-1168
Phone: (508) 588-1505
Fax: (508) 588-1508
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Nephrology 207RN0300X 34685 Massachusetts

Profile Details

NPI number 1659379857
LBN Legal business name Chung, Tai Jin
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 12th, 2005
Last updated Feb 8th, 2012 - about 13 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1659379857 NPPES
Other M08329 BLUE SHEILD
Other 034685 BLUE SHEILD
MEDICAID 2011115 BLUE SHEILD
Other 6457 BLUE SHEILD

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