1487970737 NPI number — DR. ALICE FAITH YUO CHUNG M.D.

Table of content: DR. ALICE FAITH YUO CHUNG M.D. (NPI 1487970737)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487970737 NPI number — DR. ALICE FAITH YUO CHUNG M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHUNG
Provider First Name:
ALICE
Provider Middle Name:
FAITH YUO
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
YUO
Provider Other First Name:
ALICE
Provider Other Middle Name:
FAITH
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1487970737
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/04/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3723 W 12600 S
Provider Second Line Business Mailing Address:
SUITE 270A
Provider Business Mailing Address City Name:
RIVERTON
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84065-7295
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
801-285-4620
Provider Business Mailing Address Fax Number:
801-285-4699

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3723 W 12600 S
Provider Second Line Business Practice Location Address:
SUITE 270A
Provider Business Practice Location Address City Name:
RIVERTON
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84065-7295
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-285-4620
Provider Business Practice Location Address Fax Number:
801-285-4699
Provider Enumeration Date:
04/12/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208600000X , with the licence number:  8138565-1205 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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