Provider Demographics
NPI:1033142971
Name:CHUNG, CHUNG U (MD)
Entity Type:Individual
Prefix:DR
First Name:CHUNG
Middle Name:U
Last Name:CHUNG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:4053 TAYLOR RD
Mailing Address - Street 2:SUITE K
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23321-5537
Mailing Address - Country:US
Mailing Address - Phone:757-638-0085
Mailing Address - Fax:757-686-3025
Practice Address - Street 1:2595 VICTORY BLVD
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23702-2315
Practice Address - Country:US
Practice Address - Phone:757-487-4949
Practice Address - Fax:757-487-5265
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101026927207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA073346OtherANTHEM
VAB09626Medicare UPIN