Healthcare Provider Details

I. General information

NPI: 1770512055
Provider Name (Legal Business Name): SANG K. CHUNG, M.D., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 EAST ST
WHITINSVILLE MA
01588-1923
US

IV. Provider business mailing address

130 EAST ST
WHITINSVILLE MA
01588-1923
US

V. Phone/Fax

Practice location:
  • Phone: 508-234-7311
  • Fax:
Mailing address:
  • Phone: 508-234-7311
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number34013
License Number StateMA

VIII. Authorized Official

Name: SHIRLEY SWART
Title or Position: OFFICE MANAGER
Credential:
Phone: 508-234-7311