Provider Demographics
NPI:1578587135
Name:CHUN, DAL (MD)
Entity Type:Individual
Prefix:DR
First Name:DAL
Middle Name:
Last Name:CHUN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:7501 GREENWAY CENTER DR
Mailing Address - Street 2:#300
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-3514
Mailing Address - Country:US
Mailing Address - Phone:301-474-4679
Mailing Address - Fax:
Practice Address - Street 1:8219 LEESBURG PIKE
Practice Address - Street 2:#120
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22182-2625
Practice Address - Country:US
Practice Address - Phone:703-564-4300
Practice Address - Fax:703-206-7238
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2019-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA220610207W00000X
MDD73940207W00000X, 207WX0107X
VA0101232470207W00000X, 207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD334430400Medicaid
DC041273800Medicaid
VA1578587135Medicaid