Healthcare Provider Details

I. General information

NPI: 1821077868
Provider Name (Legal Business Name): HEI JIN CHUNG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2006
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1860 TOWN CENTER DR STE 120
RESTON VA
20190-5898
US

IV. Provider business mailing address

244 MADISON AVE STE 149
NEW YORK NY
10016-2817
US

V. Phone/Fax

Practice location:
  • Phone: 858-295-0501
  • Fax: 308-646-6140
Mailing address:
  • Phone: 301-900-6334
  • Fax: 301-859-4620

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberMD074263L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number25MA07293400
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberD0107121
License Number StateMD
# 4
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number0101254253
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: