Healthcare Provider Details

I. General information

NPI: 1871753665
Provider Name (Legal Business Name): JANE S CHUNG M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2008
Last Update Date: 12/03/2024
Certification Date: 12/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5700 DALLAS PKWY
FRISCO TX
75034-9580
US

IV. Provider business mailing address

2222 WELBORN ST
DALLAS TX
75219-3924
US

V. Phone/Fax

Practice location:
  • Phone: 469-515-7100
  • Fax: 214-443-7309
Mailing address:
  • Phone: 214-559-5000
  • Fax: 214-443-7309

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080S0010X
TaxonomyPediatric Sports Medicine Physician
License NumberQ7027
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberQ7027
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: