Healthcare Provider Details

I. General information

NPI: 1578813499
Provider Name (Legal Business Name): ANNIE CHUNG PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2012
Last Update Date: 02/24/2023
Certification Date: 02/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2975 HALEKO RD SUITE #307
LIHUE HI
96766-2022
US

IV. Provider business mailing address

3-2600 KAUMUALII HWY STE 1300
LIHUE HI
96766-2022
US

V. Phone/Fax

Practice location:
  • Phone: 808-482-0698
  • Fax:
Mailing address:
  • Phone: 808-482-0698
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number750
License Number StateHI
# 2
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number750
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: