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General NPI Number Information
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NPI Number | 1952582041
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Entity Type | Individual
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Provider Name | JIN YOUNG CHUNG D.O.
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Gender | Female
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Dates
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Enumeration Date | 11/17/2007
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Last Update Date | 11/17/2007
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Provider Practice Location Address
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Address Line | 901 E MOUNT HOPE AVE
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City | LANSING
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State | MI
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Zip | 48910-3207
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Country | US
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Telephone | 517-267-3401
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Fax |
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Provider Business Mailing Address
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Address Line | 425 RYDER RD APT 315
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City | LANSING
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State | MI
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Zip | 48917-1016
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Country | US
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Telephone |
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 5101016606
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License Number State | MI
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