Healthcare Provider Details

I. General information

NPI: 1164737409
Provider Name (Legal Business Name): SUNG CHOU CHEN L.M.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2010
Last Update Date: 08/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1276 NW FEDERAL HWY
STUART FL
34994-1002
US

IV. Provider business mailing address

1276 NW FEDERAL HWY
STUART FL
34994-1002
US

V. Phone/Fax

Practice location:
  • Phone: 772-812-1882
  • Fax:
Mailing address:
  • Phone: 772-812-1882
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMA#29988
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: