| NPI | 1376989459 |
|---|---|
| Former Name | TIFFANY GRACE CHUNG |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0006X Pediatrics, Developmental - Behavioral Pediatrics (Licence: MI 4301102880) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MI 4301102880) |
| Enumeration Date | 2013-05-16 |
| Last Update Date | 2019-07-10 |