Provider Demographics
NPI:1548448715
Name:CHUNG, KAY KYUNGSOOK (RPH)
Entity type:Individual
Prefix:MRS
First Name:KAY
Middle Name:KYUNGSOOK
Last Name:CHUNG
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11000 RUTLEDGE DR
Mailing Address - Street 2:
Mailing Address - City:NORTH POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20878-2504
Mailing Address - Country:US
Mailing Address - Phone:301-610-6067
Mailing Address - Fax:
Practice Address - Street 1:12028 CHERRY HILL RD
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-1949
Practice Address - Country:US
Practice Address - Phone:301-572-5462
Practice Address - Fax:301-572-5798
Is Sole Proprietor?:No
Enumeration Date:2008-02-09
Last Update Date:2008-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD09610183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD09610OtherSTATE LICENSE NUMBER