Provider Demographics
NPI:1427151612
Name:CHUNG, ANDREW K (MD)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:K
Last Name:CHUNG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8525 ROLLING RD STE 220
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20110-3648
Mailing Address - Country:US
Mailing Address - Phone:703-393-0700
Mailing Address - Fax:
Practice Address - Street 1:8525 ROLLING RD STE 220
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20110-3648
Practice Address - Country:US
Practice Address - Phone:703-393-0700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2019-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101236182208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA306085OtherANTHEM BC/BS
VA1427151612Medicaid
VAI17858Medicare UPIN
VA015809P70Medicare PIN
VA1427151612Medicaid