Provider Demographics
NPI:1659385623
Name:KOUCH, PHENG BUN (DC)
Entity Type:Individual
Prefix:DR
First Name:PHENG
Middle Name:BUN
Last Name:KOUCH
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 UNION ST
Mailing Address - Street 2:
Mailing Address - City:NATICK
Mailing Address - State:MA
Mailing Address - Zip Code:01760-4784
Mailing Address - Country:US
Mailing Address - Phone:508-654-3500
Mailing Address - Fax:833-654-3500
Practice Address - Street 1:70 NEW OCEAN ST
Practice Address - Street 2:
Practice Address - City:SWAMPSCOTT
Practice Address - State:MA
Practice Address - Zip Code:01907-1831
Practice Address - Country:US
Practice Address - Phone:781-581-7300
Practice Address - Fax:781-581-1990
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3065111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor