Provider Demographics
NPI:1548492838
Name:CHUNG, NICOLE F (PSYD)
Entity type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:F
Last Name:CHUNG
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 460661
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94146-0661
Mailing Address - Country:US
Mailing Address - Phone:415-857-0383
Mailing Address - Fax:888-859-2631
Practice Address - Street 1:582 MARKET ST STE 601
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94104
Practice Address - Country:US
Practice Address - Phone:415-857-0383
Practice Address - Fax:888-859-2631
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-20
Last Update Date:2022-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY27721103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical