Healthcare Provider Details

I. General information

NPI: 1720032840
Provider Name (Legal Business Name): ROBERTA GAIL CHUNG M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2006
Last Update Date: 10/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 E OAKLAND AVE
OCOEE FL
34761-2233
US

IV. Provider business mailing address

17 E OAKLAND AVE
OCOEE FL
34761-2233
US

V. Phone/Fax

Practice location:
  • Phone: 877-423-1330
  • Fax: 407-877-2166
Mailing address:
  • Phone: 877-423-1330
  • Fax: 407-877-2166

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME81856
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: