Healthcare Provider Details

I. General information

NPI: 1437687563
Provider Name (Legal Business Name): CHUNG KIEFER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHUNG MARTIN RN

II. Dates (important events)

Enumeration Date: 06/02/2017
Last Update Date: 06/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2716 W CENTRAL AVE
WICHITA KS
67203-4904
US

IV. Provider business mailing address

934 N WATER ST
WICHITA KS
67203-3838
US

V. Phone/Fax

Practice location:
  • Phone: 316-660-7300
  • Fax:
Mailing address:
  • Phone: 316-660-7600
  • Fax: 316-941-5075

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number13-68526-012
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: