Healthcare Provider Details

I. General information

NPI: 1093178923
Provider Name (Legal Business Name): JEFFREY Y H CHUNG LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2016
Last Update Date: 03/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14201 LAUREL PARK DR STE 104
LAUREL MD
20707-5203
US

IV. Provider business mailing address

311 PARK PLACE BLVD FL 5
CLEARWATER FL
33759-4904
US

V. Phone/Fax

Practice location:
  • Phone: 727-755-0693
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License NumberD67554
License Number StateMD

VIII. Authorized Official

Name: ARIANA BEDOYA
Title or Position: CREDENTIALING MANAGER
Credential:
Phone: 727-755-0693