Provider Demographics
NPI:1356456735
Name:CHUN, KELLY (MD)
Entity Type:Individual
Prefix:DR
First Name:KELLY
Middle Name:
Last Name:CHUN
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 1:460 MCLAWS CIR
Mailing Address - Street 2:SUITE 130
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23185-5671
Mailing Address - Country:US
Mailing Address - Phone:757-253-7651
Mailing Address - Fax:757-253-7502
Practice Address - Street 1:460 MCLAWS CIR
Practice Address - Street 2:SUITE 130
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23185-5671
Practice Address - Country:US
Practice Address - Phone:757-253-7651
Practice Address - Fax:757-253-7502
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2015-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01012222922084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAW8578BMedicare PIN
E95237Medicare UPIN