Provider Demographics
NPI:1013948462
Name:CHUNG, MICHAEL SUNG (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:SUNG
Last Name:CHUNG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2826 OLD LEE HWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-4323
Mailing Address - Country:US
Mailing Address - Phone:703-206-0026
Mailing Address - Fax:703-206-0029
Practice Address - Street 1:2826 OLD LEE HWY
Practice Address - Street 2:SUITE 200
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-4323
Practice Address - Country:US
Practice Address - Phone:703-206-0026
Practice Address - Fax:703-206-0029
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2015-07-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA01010558982081P2900X
VAD0051996225400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD495211100Medicaid
VA6802117Medicaid
VA951550Medicare ID - Type Unspecified
MD495211100Medicaid