Provider Demographics
NPI:1417973009
Name:KUNG PLASTIC SURGERY, P.A.
Entity Type:Organization
Organization Name:KUNG PLASTIC SURGERY, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:S
Authorized Official - Last Name:KUNG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-986-8878
Mailing Address - Street 1:5454 WISCONSIN AVE
Mailing Address - Street 2:SUITE 635
Mailing Address - City:CHEVY CHASE
Mailing Address - State:MD
Mailing Address - Zip Code:20815-6901
Mailing Address - Country:US
Mailing Address - Phone:301-986-8878
Mailing Address - Fax:301-986-8879
Practice Address - Street 1:5454 WISCONSIN AVE
Practice Address - Street 2:SUITE 635
Practice Address - City:CHEVY CHASE
Practice Address - State:MD
Practice Address - Zip Code:20815-6901
Practice Address - Country:US
Practice Address - Phone:301-986-8878
Practice Address - Fax:301-986-8879
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-15
Last Update Date:2008-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD537372086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
G76733Medicare UPIN
490167Medicare ID - Type Unspecified