Healthcare Provider Details

I. General information

NPI: 1306969134
Provider Name (Legal Business Name): CYNTHIA CHUNG M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22250 PROVIDENCE DR SUITE 500
SOUTHFIELD MI
48075-4825
US

IV. Provider business mailing address

26440 BERG RD APT 1005
SOUTHFIELD MI
48034-5394
US

V. Phone/Fax

Practice location:
  • Phone: 248-849-3441
  • Fax:
Mailing address:
  • Phone: 248-736-0727
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number4301086358
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: