MEDICARE: DR. HYUN JIN CHUNG PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC2200X	Clinical Child & Adolescent Psychologist	PS01854	RI

General Provider Information

NPI Number	:	1184222077
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HYUN JIN CHUNG PHD

Provider Business Mailing Address
First Line	:	39 HAMPDEN RD
Second Line	:
City	:	EAST FALMOUTH
State	:	MA
Zip	:	02536-6457
Country	:	US
Telephone Number	:	401-575-0381
Fax Number	:

Provider Business Practice Location Address
First Line	:	789 PARK AVE
Second Line	:
City	:	CRANSTON
State	:	RI
Zip	:	02910-2036
Country	:	US
Telephone Number	:	401-421-4561
Fax Number	:	401-243-3001

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/13/2020
Last Update Date	:	10/13/2020

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