Provider Demographics
NPI:1720462252
Name:CHUNG, SHIH-CHIA (APRN)
Entity type:Individual
Prefix:
First Name:SHIH-CHIA
Middle Name:
Last Name:CHUNG
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:100 E LIBERTY ST STE 800
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-1428
Mailing Address - Country:US
Mailing Address - Phone:502-540-3383
Mailing Address - Fax:502-540-3393
Practice Address - Street 1:4402 CHURCHMAN AVE STE 300
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40215-3101
Practice Address - Country:US
Practice Address - Phone:502-363-0588
Practice Address - Fax:502-363-0972
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-14
Last Update Date:2018-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY00000163WR0006X
KY3011778363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant