Provider Demographics
NPI:1912588187
Name:CHUN, SALLY
Entity type:Individual
Prefix:
First Name:SALLY
Middle Name:
Last Name:CHUN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:152 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11211-8767
Mailing Address - Country:US
Mailing Address - Phone:212-385-3700
Mailing Address - Fax:212-385-3703
Practice Address - Street 1:152 BROADWAY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11211-8767
Practice Address - Country:US
Practice Address - Phone:212-385-3700
Practice Address - Fax:212-385-3703
Is Sole Proprietor?:No
Enumeration Date:2021-04-19
Last Update Date:2025-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant