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NPI Code Detail

MEDICARE: JESSICA CHUNG OD

MEDICARE: JESSICA CHUNG OD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1152W00000XOptometrist5624MA
2390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1740972876
Entity Type Code : Individual
Provider Name (Legal Business Name) : JESSICA CHUNG OD
Provider Business Mailing Address
First Line : 1 LYONS ST
Second Line :
City : DEDHAM
State : MA
Zip : 02026-5599
Country : US
Telephone Number : 617-657-6455
Fax Number :
Provider Business Practice Location Address
First Line : 1 LYONS ST
Second Line :
City : DEDHAM
State : MA
Zip : 02026-5599
Country : US
Telephone Number : 617-657-6455
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/25/2023
Last Update Date : 04/08/2026

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Directions to “ JESSICA CHUNG OD” Practice Location

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