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General NPI Number Information
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NPI Number | 1659861557
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Entity Type | Individual
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Provider Name | DANIEL W. CHUNG CSA
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Gender | Male
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Dates
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Enumeration Date | 05/16/2018
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Last Update Date | 11/16/2020
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Provider Practice Location Address
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Address Line | 3300 GALLOWS RD
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City | FALLS CHURCH
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State | VA
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Zip | 22042-3307
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Country | US
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Telephone | 703-776-5900
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Fax |
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Provider Business Mailing Address
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Address Line | 119 COURTHOUSE MANOR DR
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City | STAFFORD
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State | VA
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Zip | 22554-7347
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Country | US
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Telephone | 703-943-6317
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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 | 246ZC0007X
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Taxonomy Name | Surgical Assistant
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License Number | 4894
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 4894
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License Number State |
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