Provider Demographics
NPI:1003819814
Name:CHUNG, JEY-DEA (MD)
Entity Type:Individual
Prefix:DR
First Name:JEY-DEA
Middle Name:
Last Name:CHUNG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3605
Mailing Address - Street 2:
Mailing Address - City:RADFORD
Mailing Address - State:VA
Mailing Address - Zip Code:24143-3605
Mailing Address - Country:US
Mailing Address - Phone:540-731-1989
Mailing Address - Fax:540-639-5426
Practice Address - Street 1:2900 LAMB CIR
Practice Address - Street 2:STE 340
Practice Address - City:CHRISTIANSBURG
Practice Address - State:VA
Practice Address - Zip Code:24073-6344
Practice Address - Country:US
Practice Address - Phone:866-224-2413
Practice Address - Fax:540-776-0699
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2010-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101026099207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA5793831Medicaid
VA5793831Medicaid
VA051949572Medicare PIN