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NPI Code Detail

MEDICARE: DR MIRIAM CHUNG DDS PC

MEDICARE: DR MIRIAM CHUNG DDS PC
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
1261QD0000XDental Clinic/CenterDN1857812MA

General Provider Information

NPI Number : 1902313646
Entity Type Code : Organization
Provider Name (Legal Business Name) : DR MIRIAM CHUNG DDS PC
Provider Business Mailing Address
First Line : 3450 WAYNE AVE APT 19D
Second Line :
City : BRONX
State : NY
Zip : 10467-0833
Country : US
Telephone Number : 646-812-3022
Fax Number :
Provider Business Practice Location Address
First Line : 1096 REVERE BEACH PKWY
Second Line :
City : CHELSEA
State : MA
Zip : 02150-1454
Country : US
Telephone Number : 646-812-3022
Fax Number :
Authorized Official
Title or Position : CEO
Name : DR. MIRIAM CHUNG
Credential : DDS
Telephone Number : 646-812-3022
Provider Enumeration Date : 01/03/2018
Last Update Date : 01/03/2018

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