1346390408 NPI number — DR. JAE SUNG CHUNG MD

Table of content: DR. JAE SUNG CHUNG MD (NPI 1346390408)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346390408 NPI number — DR. JAE SUNG CHUNG MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHUNG
Provider First Name:
JAE
Provider Middle Name:
SUNG
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1346390408
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10301 STRATHMORE HALL ST APT 218
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORTH BETHESDA
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20852-6684
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-897-4767
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9470 ANNAPOLIS RD
Provider Second Line Business Practice Location Address:
306
Provider Business Practice Location Address City Name:
LANHAM
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20706-3025
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-459-1691
Provider Business Practice Location Address Fax Number:
301-577-2473
Provider Enumeration Date:
01/11/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  D19250 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1211 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com