Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 4301059908 | MI |
Y | 208600000X | Surgeon | 4301059908 | MI |
N | 2082S0105X | Plastic Hand Surgeon | 4301059908 | MI |
NPI | 1063510881 |
---|---|
Provider Name | Kevin Chi Chung |
First Address | Ann Arbor, MI 48108-1633 |
Second Address | Ann Arbor, MI 48105-9484 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2006 |
Last Update Date | 07/05/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3157110 | (05) | MI |
F91113 | (02) | MI |