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General NPI Number Information
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NPI Number | 1780947796
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Entity Type | Individual
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Provider Name | JENNIFER CHUN
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Gender | Female
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Dates
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Enumeration Date | 06/25/2012
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Last Update Date | 06/25/2012
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Provider Practice Location Address
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Address Line | 16216 UNION TPKE
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City | FRESH MEADOWS
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State | NY
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Zip | 11366-1958
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Country | US
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Telephone | 718-264-7922
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Fax |
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Provider Business Mailing Address
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Address Line | 118 SHRUB HOLLOW RD
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City | ROSLYN
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State | NY
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Zip | 11576-3126
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Country | US
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Telephone | 917-767-1187
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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