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NPI Code Detail

MEDICARE: SHARON KEUN HAE CHUNG LICSW

MEDICARE: SHARON KEUN HAE CHUNG LICSW
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
11041C0700XClinical Social Worker25765MN

General Provider Information

NPI Number : 1821611146
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHARON KEUN HAE CHUNG LICSW
Provider Business Mailing Address
First Line : 2739 RANDOLPH ST NE
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55418-2621
Country : US
Telephone Number : 347-406-3782
Fax Number :
Provider Business Practice Location Address
First Line : 5700 BOTTINEAU BLVD STE 100
Second Line :
City : CRYSTAL
State : MN
Zip : 55429-3184
Country : US
Telephone Number : 763-504-6590
Fax Number : 763-531-2105
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/20/2020
Last Update Date : 05/20/2020

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