Individual
MR. SHANE OLIVER CHUNG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
SFIDC
Contact information
Practice address
302 WARREN STREET APT 3, NORFOLK, VA 23505
(914) 612-3554
Mailing address
302 WARREN STREET APT 3, NORFOLK, VA 23505
(914) 612-3554
Taxonomy
Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary
—
—
Other
Enumeration date
06/25/2009
Last updated
06/25/2009
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