Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | TUV004267 | NY |
NPI | 1003902883 |
---|---|
Provider Name | Henry Chaung |
First Address | New York, NY 10013-4740 |
Second Address | New York, NY 10013-4740 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/10/2006 |
Last Update Date | 05/04/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00941135 | (05) | NY |
57979 | (02) | NY |