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General NPI Number Information
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NPI Number | 1568868693
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Entity Type | Organization
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Legal Business Name | CHI WHAN CHUNG DDS PC
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Dates
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Enumeration Date | 11/18/2014
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Last Update Date | 11/18/2014
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Provider Practice Location Address
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Address Line | 3611 CHAIN BRIDGE RD STE B
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City | FAIRFAX
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State | VA
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Zip | 22030-3246
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Country | US
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Telephone | 703-273-8450
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Fax | 703-649-6357
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Provider Business Mailing Address
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Address Line | 3611 CHAIN BRIDGE RD STE B
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City | FAIRFAX
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State | VA
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Zip | 22030-3246
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | DR. CHI WHAN CHUNG
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Credential | DDS
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Telephone | 703-273-8450
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 0401412213
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License Number State | VA
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