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General NPI Number Information
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NPI Number | 1851643654
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Entity Type | Organization
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Legal Business Name | VALLEY VASCULAR ASSOCIATES LLC
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Dates
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Enumeration Date | 10/04/2012
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Last Update Date | 10/04/2012
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Provider Practice Location Address
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Address Line | 91 EAST AVE
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City | NORWALK
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State | CT
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Zip | 06851-5020
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Country | US
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Telephone | 203-855-9806
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Fax | 203-855-1135
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Provider Business Mailing Address
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Address Line | 91 EAST AVE
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City | NORWALK
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State | CT
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Zip | 06851-5020
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Country | US
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Telephone | 203-855-9806
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Fax | 203-855-1135
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Authorized Official
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Title or Position | MANAGING OFFICER
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Name | DR. CHUNG K SHIN
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Credential | M.D.
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Telephone | 203-855-9806
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number | 037720
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License Number State | CT
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