Provider Demographics
NPI:1245025451
Name:CHUNGAG, KENNETH (NP)
Entity type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:
Last Name:CHUNGAG
Suffix:
Gender:
Credentials:NP
Other - Prefix:MR
Other - First Name:KENNETH
Other - Middle Name:Z
Other - Last Name:CHUNGAG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:8235 FRESNO LN APT 101
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22309-3635
Mailing Address - Country:US
Mailing Address - Phone:571-231-4364
Mailing Address - Fax:
Practice Address - Street 1:1023 ANTONIO DR
Practice Address - Street 2:
Practice Address - City:READING
Practice Address - State:PA
Practice Address - Zip Code:19605-2770
Practice Address - Country:US
Practice Address - Phone:248-875-6924
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-10
Last Update Date:2025-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024193200363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health