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General NPI Number Information
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NPI Number | 1699153429
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Entity Type | Individual
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Provider Name | MIRIAM ELIZABETH CHUNG DDS
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Gender | Female
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Dates
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Enumeration Date | 05/13/2015
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Last Update Date | 05/13/2015
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Provider Practice Location Address
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Address Line | 405 LEXINGTON AVE SUITE 6900
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City | NEW YORK
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State | NY
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Zip | 10174-0002
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Country | US
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Telephone | 215-594-9364
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Fax |
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Provider Business Mailing Address
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Address Line | 3450 WAYNE AVE APT 9K
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City | BRONX
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State | NY
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Zip | 10467-2510
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Country | US
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Telephone | 215-594-9364
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223D0004X
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Taxonomy Name | Dental Anesthesiology
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License Number | 057798
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License Number State | NY
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