Healthcare Provider Details

I. General information

NPI: 1679137699
Provider Name (Legal Business Name): KATHERINE CHUNG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2019
Last Update Date: 06/07/2024
Certification Date: 06/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 ORLEANS ST
BALTIMORE MD
21287-0010
US

IV. Provider business mailing address

929 BARN VIEW LN
BREINIGSVILLE PA
18031-1351
US

V. Phone/Fax

Practice location:
  • Phone: 410-955-4100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberD0100570
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: