Provider Demographics
NPI:1669455317
Name:CHUNG, CHAN K (MD)
Entity Type:Individual
Prefix:DR
First Name:CHAN
Middle Name:K
Last Name:CHUNG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1400
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22038-1400
Mailing Address - Country:US
Mailing Address - Phone:703-383-9543
Mailing Address - Fax:703-383-9532
Practice Address - Street 1:7600 CARROLL AVE
Practice Address - Street 2:C/O WASHINGTON ADVENTIST HOSPITAL
Practice Address - City:TAKOMA PARK
Practice Address - State:MD
Practice Address - Zip Code:20912-6367
Practice Address - Country:US
Practice Address - Phone:301-891-5100
Practice Address - Fax:301-891-5423
Is Sole Proprietor?:No
Enumeration Date:2005-11-28
Last Update Date:2012-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD278702085R0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0203XAllopathic & Osteopathic PhysiciansRadiologyTherapeutic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD39968901OtherCAREFIRST OF MD
920001089OtherRR MEDICARE
DC65670001OtherCAREFIRST OF DC
MD258821800Medicaid
DC023414900Medicaid
DC65670001OtherDC CAREFIRST
D05979Medicare UPIN
920001089OtherRR MEDICARE
DC023414900Medicaid