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General NPI Number Information
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NPI Number | 1699386797
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Entity Type | Individual
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Provider Name | MAYLA FUNG CHUNG PA-C
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Gender | Female
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Dates
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Enumeration Date | 08/12/2020
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Last Update Date | 12/08/2025
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Provider Practice Location Address
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Address Line | 16817 MARVIN RD
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City | CHARLOTTE
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State | NC
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Zip | 28277-2196
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Country | US
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Telephone | 704-495-6334
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Fax |
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Provider Business Mailing Address
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Address Line | 5960 FAIRVIEW RD STE 500
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City | CHARLOTTE
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State | NC
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Zip | 28210-3113
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Country | US
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Telephone | 704-495-6334
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 0010-10887
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License Number State | NC
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