Healthcare Provider Details

I. General information

NPI: 1407884604
Provider Name (Legal Business Name): WOON-MAN CHUNG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1215 E MICHIGAN AVE
LANSING MI
48912-1811
US

IV. Provider business mailing address

271 WOODLAND PASS SUITE 120
EAST LANSING MI
48823-2060
US

V. Phone/Fax

Practice location:
  • Phone: 517-364-2315
  • Fax: 517-372-1617
Mailing address:
  • Phone: 517-351-4905
  • Fax: 517-351-4820

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number4301036105
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: