MEDICARE: MS. ANGELA UN CHONG PA

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	363A00000X	Physician Assistant	0110002214	VA
2	363AM0700X	Medical Physician Assistant	009183-1	NY

General Provider Information

NPI Number	:	1881874741
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ANGELA UN CHONG PA

Provider Business Mailing Address
First Line	:	4401 FRANCIS LEWIS BLVD
Second Line	:	STE L3A
City	:	BAYSIDE
State	:	NY
Zip	:	11361-3028
Country	:	US
Telephone Number	:	718-423-3355
Fax Number	:	718-423-3721

Provider Business Practice Location Address
First Line	:	4401 FRANCIS LEWIS BLVD
Second Line	:	STE L3A
City	:	BAYSIDE
State	:	NY
Zip	:	11361-3028
Country	:	US
Telephone Number	:	718-423-3355
Fax Number	:	718-423-3721

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

Provider Enumeration Date	:	11/08/2007
Last Update Date	:	03/09/2021

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