Individual
STACEY CHUNG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
830 HARRISON AVENUE, 3RD FL, MOAKLEY BLDG, BOSTON, MA 02118-2690
(617) 638-6428
(617) 638-5756
Mailing address
960 MASSACHUSETTS AVENUE, FL 2, BOSTON, MA 02118-2690
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA8638
MA
363A00000X
Physician Assistant
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
11091269A
—
MA
Enumeration date
01/04/2022
Last updated
03/08/2023
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