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NPI Code Detail

MEDICARE: LEEANNE VICTORIA CHUNG PA-C

MEDICARE: LEEANNE VICTORIA CHUNG PA-C
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
1363A00000XPhysician Assistant024810-01NY

General Provider Information

NPI Number : 1972116259
Entity Type Code : Individual
Provider Name (Legal Business Name) : LEEANNE VICTORIA CHUNG PA-C
Provider Business Mailing Address
First Line : 640 LONDON RD
Second Line :
City : YORKTOWN HEIGHTS
State : NY
Zip : 10598-2513
Country : US
Telephone Number : 914-629-6966
Fax Number :
Provider Business Practice Location Address
First Line : 1275 YORK AVE
Second Line :
City : NEW YORK
State : NY
Zip : 10065-6007
Country : US
Telephone Number : 914-629-6966
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/26/2020
Last Update Date : 11/24/2020

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