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1578149670
DEREK SHANE CHUNG
SAINT LOUIS, MO
NPI
1578149670
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
390200000X Student in an Organized Health Care Education/Training Program
Enumeration Date
2021-03-20
Last Update Date
2021-03-20
Business Address
DEREK SHANE CHUNG DO
1402 S GRAND BLVD # M260
SAINT LOUIS, MO 63104-1004
Phone number: 314-977-1753
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Mailing Address
DEREK SHANE CHUNG DO
1724 HOMESTEAD DR
LIBERTY, MO 64068-7183
Phone number: 816-288-9115
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