Active NPI
Polly Clare Chung, RD CDE
- Registered Dietitian
- Detroit, MI
National Provider Identifier
1326185943
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- TO BE ISSUED 2007
- Practice address
- 3031 West Grand Boulevard
Henry Ford Hospital Endocrinology
Detroit, MI 48202-3141 - Phone
- (313) 916-2127
- Fax
- (313) 916-8343
- NPI assigned
- Jan 31, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | TO BE ISSUED 2007 | MI | Primary |
Addresses
Primary practice location
3031 West Grand Boulevard
Henry Ford Hospital Endocrinology
Detroit, MI 48202-3141
Mailing address
2428 London Dr
Troy, MI 48085-3536
Phone (248) 524-9547
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| TO BE ISSUED 2007 | MI | MD | Registered Dietitian |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170201600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1326185943",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2428 LONDON DR",
"city": "TROY",
"state": "MI",
"postal_code": "480853536",
"telephone_number": "248-524-9547",
"fax_number": "248-524-9547"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3031 WEST GRAND BOULEVARD",
"address_2": "HENRY FORD HOSPITAL ENDOCRINOLOGY",
"city": "DETROIT",
"state": "MI",
"postal_code": "482023141",
"telephone_number": "313-916-2127",
"fax_number": "313-916-8343"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CHUNG",
"first_name": "POLLY",
"middle_name": "CLARE",
"credential": "RD CDE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-01-31",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "MI",
"license": "TO BE ISSUED 2007",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Detroit, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.