Provider Demographics
NPI:1396044343
Name:CHUNG, KAP JIN (RPH)
Entity Type:Individual
Prefix:MR
First Name:KAP
Middle Name:JIN
Last Name:CHUNG
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14317 STILTON CIR
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20905-5991
Mailing Address - Country:US
Mailing Address - Phone:301-646-4816
Mailing Address - Fax:
Practice Address - Street 1:1823 E WEST HWY
Practice Address - Street 2:
Practice Address - City:ADELPHI
Practice Address - State:MD
Practice Address - Zip Code:20783-3032
Practice Address - Country:US
Practice Address - Phone:301-439-7100
Practice Address - Fax:301-439-7134
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-16
Last Update Date:2011-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD10007183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist