MEDICARE: PHILIP R CHUNG M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician	L7335	TX
2	207W00000X	Ophthalmology Physician	0101239485	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1902809684
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PHILIP R CHUNG M.D.

Provider Business Mailing Address
First Line	:	7300 HERITAGE VILLAGE PLZ
Second Line	:	SUITE 101
City	:	GAINESVILLE
State	:	VA
Zip	:	20155-3079
Country	:	US
Telephone Number	:	703-753-4733
Fax Number	:	703-753-2183

Provider Business Practice Location Address
First Line	:	7300 HERITAGE VILLAGE PLZ
Second Line	:	SUITE 101
City	:	GAINESVILLE
State	:	VA
Zip	:	20155-3079
Country	:	US
Telephone Number	:	703-753-4733
Fax Number	:	703-753-2183

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	10/15/2013

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Directions to “ PHILIP R CHUNG M.D.” Practice Location

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