Provider Demographics
NPI:1578729216
Name:TAE JOON CHUNG, MD PC
Entity Type:Organization
Organization Name:TAE JOON CHUNG, MD PC
Other - Org Name:RESTON RHEUMATOLOGY AND ARTHRITIS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TAE
Authorized Official - Middle Name:JOON
Authorized Official - Last Name:CHUNG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-668-0700
Mailing Address - Street 1:1830 TOWN CENTER DR
Mailing Address - Street 2:SUITE 308
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20190-3292
Mailing Address - Country:US
Mailing Address - Phone:703-668-0700
Mailing Address - Fax:703-668-0707
Practice Address - Street 1:1830 TOWN CENTER DR
Practice Address - Street 2:SUITE 308
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190-3292
Practice Address - Country:US
Practice Address - Phone:703-668-0700
Practice Address - Fax:703-668-0707
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-01
Last Update Date:2010-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101232063207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAG01539Medicare Oscar/Certification
VAG01539Medicare PIN
VAG01539Medicare UPIN