Basic Information
| Provider Information | |||||||||
| NPI: | 1417942566 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHUNG | ||||||||
| FirstName: | TAE | ||||||||
| MiddleName: | SUNG | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | CHUNG | ||||||||
| OtherFirstName: | SCOTT | ||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | DR. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | M.D | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | LOCK BOX | ||||||||
| Address2: | P.O BOX 414768 | ||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 022414768 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7819374556 | ||||||||
| FaxNumber: | 7819376455 | ||||||||
| Practice Location | |||||||||
| Address1: | 500 HOSPITAL DR | ||||||||
| Address2: | |||||||||
| City: | WARRENTON | ||||||||
| State: | VA | ||||||||
| PostalCode: | 201863027 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5403165080 | ||||||||
| FaxNumber: | 5403165081 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/14/2005 | ||||||||
| LastUpdateDate: | 10/31/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208M00000X | 0101056148 | VA | Y | Allopathic & Osteopathic Physicians | Hospitalist |
ID Information
| ID | Type | State | Issuer | Description | 611523121 | 01 | VA | GROUP TAX ID | OTHER |