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General NPI Number Information
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NPI Number | 1790058527
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Entity Type | Organization
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Legal Business Name | DR EDMUND KP LING-CHUNG PHYSICIAN
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Dates
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Enumeration Date | 02/09/2012
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Last Update Date | 02/09/2012
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Provider Practice Location Address
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Address Line | 2627D HYLAN BLVD
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City | STATEN ISLAND
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State | NY
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Zip | 10306-4356
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Country | US
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Telephone | 718-987-6622
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Fax | 718-979-8982
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Provider Business Mailing Address
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Address Line | 2627D HYLAN BLVD
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City | STATEN ISLAND
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State | NY
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Zip | 10306-4356
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Country | US
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Telephone | 718-987-6622
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Fax | 718-979-8982
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Authorized Official
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Title or Position | OWNER
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Name | DR. EDMUND K LING-CHUNG
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Credential | M.D.
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Telephone | 718-987-6622
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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 | 153451
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License Number State | NY
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