Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 056881 | NY |
NPI | 1033507181 |
---|---|
Provider Name | Dr. Jenny Chung |
First Address | East Meadow, NY 11554 |
Second Address | East Meadow, NY 11554 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/12/2014 |
Last Update Date | 23/12/2014 |