Healthcare Provider Details

I. General information

NPI: 1962598722
Provider Name (Legal Business Name): WILLIAM HUNG PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 FRANCIS STREET
BOSTON MA
02115
US

IV. Provider business mailing address

294 GRAY STREET
ARLINGTON MA
02476-6120
US

V. Phone/Fax

Practice location:
  • Phone: 617-732-6824
  • Fax:
Mailing address:
  • Phone: 781-643-1314
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number1597
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: