Provider Demographics
NPI:1841276136
Name:CHUN, ALBERT K (MD)
Entity type:Individual
Prefix:
First Name:ALBERT
Middle Name:K
Last Name:CHUN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:26500 AGOURA RD STE 102-587
Mailing Address - Street 2:
Mailing Address - City:CALABASAS
Mailing Address - State:CA
Mailing Address - Zip Code:91302-1952
Mailing Address - Country:US
Mailing Address - Phone:818-880-8605
Mailing Address - Fax:
Practice Address - Street 1:2812 OLD LEE HWY STE 100B
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-4315
Practice Address - Country:US
Practice Address - Phone:571-279-6849
Practice Address - Fax:571-281-8697
Is Sole Proprietor?:No
Enumeration Date:2005-12-19
Last Update Date:2020-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2261162085R0202X, 2085R0204X
VA01012483352085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA468464OtherTUFTS HEALTH CARE
MA2106795Medicaid
MAJ28957OtherBLUE CROSS BLUE SHIELD
MAJ28957OtherBLUE CROSS BLUE SHIELD
I33365Medicare UPIN