Provider Demographics
NPI:1831172758
Name:CHAN K CHUNG M D P A
Entity type:Organization
Organization Name:CHAN K CHUNG M D P A
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHAN
Authorized Official - Middle Name:K
Authorized Official - Last Name:CHUNG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-891-5100
Mailing Address - Street 1:PO BOX 1400
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22038-1400
Mailing Address - Country:US
Mailing Address - Phone:703-383-9543
Mailing Address - Fax:703-383-9532
Practice Address - Street 1:7600 CARROLL AVE
Practice Address - Street 2:C/O WASHINGTON ADVENTIST HOSPITAL
Practice Address - City:TAKOMA PARK
Practice Address - State:MD
Practice Address - Zip Code:20912-6367
Practice Address - Country:US
Practice Address - Phone:301-891-5100
Practice Address - Fax:301-891-5423
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-23
Last Update Date:2010-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD278702085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
C31500OtherRR MEDICARE
DC6567OtherDC CAREFIRST
MDC492CHOtherCAREFIRST OF MD
DC047349000Medicaid
MD364191100Medicaid
D05979Medicare UPIN
MDC492CHOtherCAREFIRST OF MD
DC047349000Medicaid