Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081P2900X | Pain Medicine | 0101055898 | VA |
NPI | 1013948462 |
---|---|
Provider Name | Dr. Michael Sung Chung |
First Address | Fairfax, VA 22031-4323 |
Second Address | Fairfax, VA 22031-4323 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/07/2006 |
Last Update Date | 31/07/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
495211100 | (05) | MD |
6802117 | (05) | VA |
W86170 | (02) | VA |