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General NPI Number Information
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NPI Number | 1669455317
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Entity Type | Individual
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Provider Name | CHAN K CHUNG M.D.
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Gender | Male
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Dates
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Enumeration Date | 11/28/2005
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Last Update Date | 11/20/2012
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Provider Practice Location Address
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Address Line | 7600 CARROLL AVE C/O WASHINGTON ADVENTIST HOSPITAL
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City | TAKOMA PARK
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State | MD
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Zip | 20912-6367
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Country | US
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Telephone | 301-891-5100
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Fax | 301-891-5423
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Provider Business Mailing Address
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Address Line | PO BOX 1400
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City | FAIRFAX
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State | VA
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Zip | 22038-1400
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Country | US
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Telephone | 703-383-9543
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Fax | 703-383-9532
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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 | 2085R0203X
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Taxonomy Name | Therapeutic Radiology Physician
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License Number | D27870
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License Number State | MD
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