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General NPI Number Information
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NPI Number | 1710869581
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Entity Type | Organization
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Legal Business Name | MEDPLUS MEDICAL GROUP
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Dates
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Enumeration Date | 07/23/2025
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Last Update Date | 07/23/2025
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Provider Practice Location Address
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Address Line | 10721 MAIN ST STE 204
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City | FAIRFAX
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State | VA
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Zip | 22030-6902
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Country | US
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Telephone | 571-655-2267
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Fax |
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Provider Business Mailing Address
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Address Line | 12584 FAIR VILLAGE WAY
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City | FAIRFAX
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State | VA
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Zip | 22033-6231
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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 | DIRECTOR
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Name | MYOUNGJOO CHUNG
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Credential |
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Telephone | 571-655-2267
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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