Provider Demographics
NPI:1134580590
Name:CHUNG, AMANDA SHU JUN (B SC MBBS MS FRACS)
Entity type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:SHU JUN
Last Name:CHUNG
Suffix:
Gender:F
Credentials:B SC MBBS MS FRACS
Other - Prefix:DR
Other - First Name:AMANDA
Other - Middle Name:SHU JUN
Other - Last Name:TAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:225 CLEARFIELD AVENUE
Mailing Address - Street 2:DEPARTMENT OF UROLOGY EASTERN VIRGINIA MEDICAL SCHOOL
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462
Mailing Address - Country:US
Mailing Address - Phone:757-452-3459
Mailing Address - Fax:757-961-4099
Practice Address - Street 1:DEPARTMENT OF UROLOGY, LEVEL 4 WEST, MAIN BUILDING
Practice Address - Street 2:CONCORD REPATRIATION GENERAL HOSPITAL, HOSPITAL ROAD
Practice Address - City:CONCORD
Practice Address - State:NEW SOUTH WALES
Practice Address - Zip Code:02139
Practice Address - Country:AU
Practice Address - Phone:043-277-0105
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA390200000X, 390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0116029628OtherPROFESSIONAL LICENSE