Healthcare Provider Details

I. General information

NPI: 1336277938
Provider Name (Legal Business Name): WING KIT CHUNG LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: MR. KENNETH CHUNG

II. Dates (important events)

Enumeration Date: 03/02/2007
Last Update Date: 10/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14015 SANFORD AVE STE B 2ND FLOOR
FLUSHING NY
11355-2688
US

IV. Provider business mailing address

135 MERCER ST
JERSEY CITY NJ
07302-3401
US

V. Phone/Fax

Practice location:
  • Phone: 718-358-8288
  • Fax: 718-358-5265
Mailing address:
  • Phone: 646-710-0278
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number080047-1
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: