Healthcare Provider Details

I. General information

NPI: 1245238674
Provider Name (Legal Business Name): SUNGJI CHAI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2005
Last Update Date: 06/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 FITCH ST SUITE 102
ELMIRA NY
14905-1634
US

IV. Provider business mailing address

571 SAINT JOSEPHS BLVD FL 2
ELMIRA NY
14901-3230
US

V. Phone/Fax

Practice location:
  • Phone: 607-734-6544
  • Fax: 607-734-6580
Mailing address:
  • Phone: 607-271-2050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number2143571
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: