Healthcare Provider Details

I. General information

NPI: 1437197639
Provider Name (Legal Business Name): SUK YUEN CHUNG FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 03/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 POTRERO AVE
SAN FRANCISCO CA
94110-3518
US

IV. Provider business mailing address

1239 REDWOOD WAY
MILLBRAE CA
94030-1023
US

V. Phone/Fax

Practice location:
  • Phone: 415-206-5174
  • Fax: 415-206-5100
Mailing address:
  • Phone: 650-873-5305
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberRN328276
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: