Provider Demographics
NPI:1114610169
Name:CHUNG, ELLEN AERYUNG (MS, LAC)
Entity Type:Individual
Prefix:MS
First Name:ELLEN
Middle Name:AERYUNG
Last Name:CHUNG
Suffix:
Gender:F
Credentials:MS, LAC
Other - Prefix:MS
Other - First Name:AERYUNG
Other - Middle Name:ELLEN
Other - Last Name:CHUNG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:112 WEST 18TH STREET
Mailing Address - Street 2:4A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011
Mailing Address - Country:US
Mailing Address - Phone:917-634-7882
Mailing Address - Fax:
Practice Address - Street 1:110 WILLIAM STREET
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10038
Practice Address - Country:US
Practice Address - Phone:917-634-7882
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-26
Last Update Date:2023-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007266171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist