Provider Demographics
NPI:1447409149
Name:CLINCH VALLEY SURGICAL ASSOCIATES PC
Entity Type:Organization
Organization Name:CLINCH VALLEY SURGICAL ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HONG
Authorized Official - Middle Name:J
Authorized Official - Last Name:JUN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:276-596-6631
Mailing Address - Street 1:2951 FRONT ST
Mailing Address - Street 2:SUITE 3800
Mailing Address - City:RICHLANDS
Mailing Address - State:VA
Mailing Address - Zip Code:24641-2055
Mailing Address - Country:US
Mailing Address - Phone:276-596-6631
Mailing Address - Fax:276-596-6633
Practice Address - Street 1:2951 FRONT ST
Practice Address - Street 2:SUITE 3800
Practice Address - City:RICHLANDS
Practice Address - State:VA
Practice Address - Zip Code:24641-2055
Practice Address - Country:US
Practice Address - Phone:276-596-6631
Practice Address - Fax:276-596-6633
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-17
Last Update Date:2008-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101242107208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1689713620OtherINDIVIDUAL NPI