Healthcare Provider Details

I. General information

NPI: 1023877677
Provider Name (Legal Business Name): MACY MEISZE CHUNG RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2024
Last Update Date: 03/18/2024
Certification Date: 03/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28 COLE ST APT 4
SAN FRANCISCO CA
94117-1186
US

IV. Provider business mailing address

28 COLE ST APT 4
SAN FRANCISCO CA
94117-1186
US

V. Phone/Fax

Practice location:
  • Phone: 626-975-8644
  • Fax:
Mailing address:
  • Phone: 626-975-8644
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WW0101X
TaxonomyAmbulatory Women's Health Care Registered Nurse
License Number95215065
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95215065
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: