Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | 4301086358 | MI |
NPI | 1306969134 |
---|---|
Provider Name | Cynthia Chung |
First Address | Southfield, MI 48034-5394 |
Second Address | Southfield, MI 48075-4825 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/04/2007 |
Last Update Date | 08/07/2007 |