Healthcare Provider Details

I. General information

NPI: 1730434614
Provider Name (Legal Business Name): JEANNIE H CHUNG MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2012
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 WALNUT STREET STE 202
WELLESLEY MA
02481
US

IV. Provider business mailing address

40 WALNUT ST STE 202
WELLESLEY MA
02481-2102
US

V. Phone/Fax

Practice location:
  • Phone: 781-235-3223
  • Fax: 781-235-2210
Mailing address:
  • Phone: 781-235-3223
  • Fax: 781-235-2210

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: JEANNIE CHUNG
Title or Position: OWNER
Credential: MD
Phone: 781-235-3223