MEDICARE: MR. KENNETH CHUNGAG NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	0024193200	VA

General Provider Information

NPI Number	:	1245025451
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. KENNETH CHUNGAG NP

Provider Business Mailing Address
First Line	:	8235 FRESNO LN APT 101
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22309-3635
Country	:	US
Telephone Number	:	571-231-4364
Fax Number	:

Provider Business Practice Location Address
First Line	:	1023 ANTONIO DR
Second Line	:
City	:	READING
State	:	PA
Zip	:	19605-2770
Country	:	US
Telephone Number	:	248-875-6924
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/10/2025
Last Update Date	:	04/10/2025

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