Provider Demographics
NPI:1538370127
Name:CHUNG, JENNIFER JIAN (MSNA, CRNA)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:JIAN
Last Name:CHUNG
Suffix:
Gender:F
Credentials:MSNA, CRNA
Other - Prefix:
Other - First Name:JIAN
Other - Middle Name:
Other - Last Name:WANG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1825 SAMUEL MORSE DRIVE
Mailing Address - Street 2:
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20190
Mailing Address - Country:US
Mailing Address - Phone:703-893-6168
Mailing Address - Fax:703-790-3451
Practice Address - Street 1:1825 SAMUEL MORSE DR.
Practice Address - Street 2:
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190
Practice Address - Country:US
Practice Address - Phone:703-893-6168
Practice Address - Fax:703-536-1400
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2014-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024130149367500000X
VA0001130149367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
008367M92Medicare ID - Type Unspecified