Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207U00000X | Nuclear Medicine Specialist | 51784 | MA |
NPI | 1437144706 |
---|---|
Provider Name | Johng Chun |
First Address | Brookline, MA 02446-9135 |
Second Address | Methuen, MA 01844-4597 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/09/2005 |
Last Update Date | 17/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
6197558 | (05) | MA |
B95311 | (02) |