Healthcare Provider Details

I. General information

NPI: 1770610909
Provider Name (Legal Business Name): JEANNIE HYE-JOON CHUNG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 06/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 HIGHLAND AVE
SALEM MA
01970-2721
US

IV. Provider business mailing address

107 HIGHLAND AVE
SALEM MA
01970-2721
US

V. Phone/Fax

Practice location:
  • Phone: 978-744-3223
  • Fax: 978-744-4990
Mailing address:
  • Phone: 978-744-3223
  • Fax: 978-744-4990

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0007X
TaxonomyPlastic Surgery within the Head & Neck (Otolaryngology) Physician
License Number220376
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: