Provider Demographics
NPI:1013753516
Name:CHUNG, LISA YUNJUNG
Entity type:Individual
Prefix:MISS
First Name:LISA
Middle Name:YUNJUNG
Last Name:CHUNG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:231 WHITE SAND CT
Mailing Address - Street 2:
Mailing Address - City:COLONIAL HEIGHTS
Mailing Address - State:VA
Mailing Address - Zip Code:23834-2197
Mailing Address - Country:US
Mailing Address - Phone:804-735-3031
Mailing Address - Fax:
Practice Address - Street 1:231 WHITE SAND CT
Practice Address - Street 2:
Practice Address - City:COLONIAL HEIGHTS
Practice Address - State:VA
Practice Address - Zip Code:23834-2197
Practice Address - Country:US
Practice Address - Phone:804-735-3031
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-03
Last Update Date:2024-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Multi-Specialty