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General NPI Number Information
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NPI Number | 1821611146
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Entity Type | Individual
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Provider Name | SHARON KEUN HAE CHUNG LICSW
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Gender | Female
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Dates
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Enumeration Date | 05/20/2020
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Last Update Date | 05/20/2020
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Provider Practice Location Address
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Address Line | 5700 BOTTINEAU BLVD STE 100
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City | CRYSTAL
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State | MN
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Zip | 55429-3184
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Country | US
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Telephone | 763-504-6590
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Fax | 763-531-2105
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Provider Business Mailing Address
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Address Line | 2739 RANDOLPH ST NE
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City | MINNEAPOLIS
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State | MN
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Zip | 55418-2621
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Country | US
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Telephone | 347-406-3782
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 25765
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License Number State | MN
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