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General NPI Number Information
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NPI Number | 1831210897
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Entity Type | Individual
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Provider Name | PIL SUP CHUNG M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/03/2007
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Last Update Date | 02/04/2022
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Provider Practice Location Address
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Address Line | 201 N WASHINGTON ST
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City | FALLS CHURCH
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State | VA
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Zip | 22046-4518
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Country | US
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Telephone | 215-266-1588
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Fax |
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Provider Business Mailing Address
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Address Line | 201 N WASHINGTON ST
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City | FALLS CHURCH
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State | VA
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Zip | 22046-4518
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Country | US
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Telephone | 215-266-1588
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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 | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | D0067666
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 0101248324
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License Number State | VA
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Taxonomy #3
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | MD039750
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License Number State | DC
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