Sharon Keun Hae Chung, LICSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

25765 Issued in MN

Practice address

5700 Bottineau Blvd Ste 100
Crystal, MN 55429-3184

Phone

(763) 504-6590

Fax

(763) 531-2105

NPI assigned

May 20, 2020

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Familymeans

  • Mental Health Counselor
  • Stillwater, MN
  • NPI 1881690899
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1589932800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1589932800000",
    "number": "1821611146",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2739 RANDOLPH ST NE",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554182621",
            "telephone_number": "347-406-3782"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5700 BOTTINEAU BLVD STE 100",
            "city": "CRYSTAL",
            "state": "MN",
            "postal_code": "554293184",
            "telephone_number": "763-504-6590",
            "fax_number": "763-531-2105"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHUNG",
        "first_name": "SHARON",
        "middle_name": "KEUN HAE",
        "credential": "LICSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-05-20",
        "last_updated": "2020-05-20",
        "certification_date": "2020-05-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MN",
            "license": "25765",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Delina Carpenter, PHARMD
• Virginia Carveth
• Dorothy Cheng, PHARMD
• Chez Michael Care LLC
• Bianca Xochitl Chipoco
• Jessica M Cici, MD
• Katherine Rose Clark, PA-C
• Clinique Healthcare Services, Inc
• Collective Care Outpatient Services, LLC
• Colleen Martens Endrizzi, Inc.

• Clinical Social Worker in Crystal, MN
• Providers in Crystal, MN by specialty
• Clinical Social Worker in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.