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General NPI Number Information
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NPI Number | 1467898205
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Entity Type | Individual
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Provider Name | SEUNG JOON CHUNG D.O.
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Gender | Male
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Dates
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Enumeration Date | 05/20/2013
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Last Update Date | 06/20/2021
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Provider Practice Location Address
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Address Line | 1701 TWIN SPRINGS RD
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City | HALETHORPE
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State | MD
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Zip | 21227-3553
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Country | US
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Telephone | 909-680-8860
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Fax |
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Provider Business Mailing Address
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Address Line | 7789 ARUNDEL MILLS BLVD #437
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City | HANOVER
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State | MD
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Zip | 21076-1996
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Country | US
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Telephone | 909-680-8860
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | H0081973
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License Number State | MD
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