Provider Demographics
NPI:1851643654
Name:VALLEY VASCULAR ASSOCIATES LLC
Entity Type:Organization
Organization Name:VALLEY VASCULAR ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHUNG
Authorized Official - Middle Name:K
Authorized Official - Last Name:SHIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-855-9806
Mailing Address - Street 1:91 EAST AVE
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06851-5020
Mailing Address - Country:US
Mailing Address - Phone:203-855-9806
Mailing Address - Fax:203-855-1135
Practice Address - Street 1:91 EAST AVE
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06851-5020
Practice Address - Country:US
Practice Address - Phone:203-855-9806
Practice Address - Fax:203-855-1135
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-04
Last Update Date:2012-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0377202086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT178311OtherWELLCARE
CTP2061278OtherOXFORD
CT001377200Medicaid
CT2322912OtherAETNA/US HEALTHCARE
CT770002444OtherMEDICARE RAILROAD
CT010037720CT02OtherANTHEM - DERBY
CT010037720CT03OtherANTHEM -NORWALK
CT010037720CT04OtherANTHEM - BPT
CT037720OtherCONNECTICARE
CT3324246-004OtherCIGNA
CT010037720CT04OtherANTHEM - BPT
CT770000032Medicare PIN