Healthcare Provider Details

I. General information

NPI: 1700634698
Provider Name (Legal Business Name): CHI LONG SPENCER HUNG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2024
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

780 AMERICAN LEGION HWY
ROSLINDALE MA
02131-3908
US

IV. Provider business mailing address

780 AMERICAN LEGION HWY
ROSLINDALE MA
02131-3908
US

V. Phone/Fax

Practice location:
  • Phone: 857-337-0726
  • Fax:
Mailing address:
  • Phone: 857-337-0726
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberAPCC20032
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: