Provider Demographics
NPI:1992952170
Name:CHUNG, PETER DONGIL (PA-C)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:DONGIL
Last Name:CHUNG
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6311 MARY THERESA CT
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:MD
Mailing Address - Zip Code:21076-0000
Mailing Address - Country:US
Mailing Address - Phone:302-430-1974
Mailing Address - Fax:
Practice Address - Street 1:6311 MARY THERESA CT
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:MD
Practice Address - Zip Code:21076-1028
Practice Address - Country:US
Practice Address - Phone:302-430-1974
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-19
Last Update Date:2022-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC5-0000606363A00000X
CA58763363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant