Provider Demographics
NPI:1073622742
Name:CHUNG, INGRID INSOOK (MD)
Entity Type:Individual
Prefix:MRS
First Name:INGRID
Middle Name:INSOOK
Last Name:CHUNG
Suffix:
Gender:F
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 9302
Mailing Address - Street 2:
Mailing Address - City:MCLEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22102
Mailing Address - Country:US
Mailing Address - Phone:703-378-3508
Mailing Address - Fax:703-378-6414
Practice Address - Street 1:4229 LAFAYETTE CENTER DRIVE
Practice Address - Street 2:SUITE #1790
Practice Address - City:CHANTILLY
Practice Address - State:VA
Practice Address - Zip Code:20151-1267
Practice Address - Country:US
Practice Address - Phone:703-378-3508
Practice Address - Fax:703-378-6414
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2015-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101049525207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
461868OtherAETNA
103012147OtherCIGNA
463068OtherBCBS-ANTHEM
4528765OtherAETNA
3100539OtherALLANCE PPO/MAMSI
38080001OtherBCBS-CAREFIRST
461868OtherAETNA
VAF74425Medicare UPIN
4528765OtherAETNA