Basic Information
| Provider Information | |||||||||
| NPI: | 1386693166 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HUNG | ||||||||
| FirstName: | CINDY | ||||||||
| MiddleName: | K W | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 26185 GREENFIELD RD | ||||||||
| Address2: | |||||||||
| City: | SOUTHFIELD | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480764709 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2485692040 | ||||||||
| FaxNumber: | 2485692048 | ||||||||
| Practice Location | |||||||||
| Address1: | 26185 GREENFIELD RD | ||||||||
| Address2: | |||||||||
| City: | SOUTHFIELD | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480764709 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2485692040 | ||||||||
| FaxNumber: | 2485692048 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/09/2006 | ||||||||
| LastUpdateDate: | 01/14/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 4301059337 | MI | Y | Allopathic & Osteopathic Physicians | Family Medicine | 207RG0300X | 4301059337 | MI | N | Allopathic & Osteopathic Physicians | Internal Medicine | Geriatric Medicine |
ID Information
| ID | Type | State | Issuer | Description | 4958821 | 05 | MI | MEDICAID | 080D410020 | 01 | MI | BCBSM BCN COMM BLUE CHOIC | OTHER | 1022806 | 01 | MI | MHP HAN INDIVIDUAL | OTHER | 1022853 | 01 | MI | MHP HAN GROUP | OTHER | 4428146 | 05 | MI | MEDICAID |