Provider Demographics
NPI:1619219045
Name:CHUNG, MIN SUN
Entity type:Individual
Prefix:
First Name:MIN SUN
Middle Name:
Last Name:CHUNG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11800 SUNSET HILLS RD UNIT 1026
Mailing Address - Street 2:
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20190-4800
Mailing Address - Country:US
Mailing Address - Phone:571-234-1479
Mailing Address - Fax:
Practice Address - Street 1:1035 STERLING RD STE 101
Practice Address - Street 2:
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20170-3838
Practice Address - Country:US
Practice Address - Phone:571-234-1479
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-24
Last Update Date:2019-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU02047171100000X
VA0121000717171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist