Healthcare Provider Details

I. General information

NPI: 1962855312
Provider Name (Legal Business Name): BRADLEY CHUNG
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2016
Last Update Date: 07/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5496 COCONUT BLVD
WEST PALM BEACH FL
33411-8542
US

IV. Provider business mailing address

5496 COCONUT BLVD
WEST PALM BEACH FL
33411-8542
US

V. Phone/Fax

Practice location:
  • Phone: 561-305-7268
  • Fax: 561-508-7494
Mailing address:
  • Phone: 561-305-7268
  • Fax: 561-508-7494

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: