Healthcare Provider Details

I. General information

NPI: 1982390068
Provider Name (Legal Business Name): MICHELLE C KUNG DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2023
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 LIBERTY ST
BROCKTON MA
02301-5674
US

IV. Provider business mailing address

35 ROBERTS ST
QUINCY MA
02169-6402
US

V. Phone/Fax

Practice location:
  • Phone: 508-894-0400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPDF8341
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: