Healthcare Provider Details

I. General information

NPI: 1992246185
Provider Name (Legal Business Name): MAGGIE CHUNG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2017
Last Update Date: 08/05/2022
Certification Date: 08/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 POTRERO AVENUE BLDG. 5, 1ST FLOOR
SAN FRANCISCO CA
94110
US

IV. Provider business mailing address

1502 9TH AVE
SAN FRANCISCO CA
94122-3609
US

V. Phone/Fax

Practice location:
  • Phone: 628-206-8020
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberA161526
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: