Provider Demographics
NPI:1417942566
Name:CHUNG, TAE SUNG (MD)
Entity Type:Individual
Prefix:DR
First Name:TAE
Middle Name:SUNG
Last Name:CHUNG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:SCOTT
Other - Middle Name:
Other - Last Name:CHUNG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:LOCK BOX
Mailing Address - Street 2:P.O BOX 414768
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-4768
Mailing Address - Country:US
Mailing Address - Phone:781-937-4556
Mailing Address - Fax:781-937-6455
Practice Address - Street 1:500 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:WARRENTON
Practice Address - State:VA
Practice Address - Zip Code:20186-3027
Practice Address - Country:US
Practice Address - Phone:540-316-5080
Practice Address - Fax:540-316-5081
Is Sole Proprietor?:No
Enumeration Date:2005-09-14
Last Update Date:2017-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101056148208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA611523121OtherGROUP TAX ID