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General NPI Number Information
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NPI Number | 1972079762
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Entity Type | Organization
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Legal Business Name | PRACTICE OF DR. EDWIN CHUNG
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Dates
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Enumeration Date | 10/18/2018
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Last Update Date | 10/18/2018
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Provider Practice Location Address
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Address Line | 203 3RD AVE E
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City | BRADENTON
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State | FL
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Zip | 34208-1013
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Country | US
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Telephone | 941-216-3103
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Fax | 941-921-1594
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Provider Business Mailing Address
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Address Line | 6247 ANISE DR
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City | SARASOTA
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State | FL
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Zip | 34238-5177
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Country | US
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Telephone | 941-400-1700
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Fax | 941-921-1594
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Authorized Official
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Title or Position | OWNER
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Name | EDWIN K CHUNG
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Credential | MD
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Telephone | 941-400-1700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RH0005X
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Taxonomy Name | Hypertension Specialist Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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