Provider Demographics
NPI:1558536326
Name:CHUN, EDWARD (DDS)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:
Last Name:CHUN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1313 DOLLEY MADISON BLVD
Mailing Address - Street 2:SUITE 307
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22101-3953
Mailing Address - Country:US
Mailing Address - Phone:703-847-0989
Mailing Address - Fax:703-847-2681
Practice Address - Street 1:1313 DOLLEY MADISON BLVD
Practice Address - Street 2:SUITE 307
Practice Address - City:MC LEAN
Practice Address - State:VA
Practice Address - Zip Code:22101-3953
Practice Address - Country:US
Practice Address - Phone:703-847-0989
Practice Address - Fax:703-847-2681
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-23
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014111741223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics