Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0007X | Plastic Surgeon (Head & Neck) | 2004034263 | MO |
NPI | 1164449666 |
---|---|
Provider Name | Dr. Andy Tuan Anh Chung |
First Address | Dallas, TX 75230-2576 |
Second Address | Dallas, TX 75230-2576 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/07/2006 |
Last Update Date | 17/10/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
017257 | KAISER COMMERCIAL (01) | CO |
130067 | (02) | CO |
76480330 | (05) | CO |
I30061 | (02) |