Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0004X | Dentist Anesthesiologist | 057798 | NY |
NPI | 1699153429 |
---|---|
Provider Name | Miriam Elizabeth Chung |
First Address | Bronx, NY 10467-2510 |
Second Address | New York, NY 10174-0002 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/05/2015 |
Last Update Date | 13/05/2015 |