Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | 0101026099 | VA |
NPI | 1003819814 |
---|---|
Provider Name | Dr. Jey-Dea Chung |
First Address | Radford, VA 24143-3605 |
Second Address | Christiansburg, VA 24073-6344 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/05/2005 |
Last Update Date | 26/01/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
5793831 | (05) | VA |
B09545 | (02) |