Wan Soo Chung, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

21923 Issued in NC

Practice address

307 S McCaskey Rd
Williamston, NC 27892

Phone

(252) 792-1071

Fax

(252) 792-1071

NPI assigned

Dec 5, 2006

Sex

Male

Sole proprietor

No

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Scott Chiropractic LLC

  • Chiropractor
  • Williamston, NC
  • NPI 1720692924
  NPD (past)

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jul 8, 2007.

{
    "created_epoch": "1165276800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1295893709",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "307 S MCCASKEY RD",
            "city": "WILLIAMSTON",
            "state": "NC",
            "postal_code": "27892",
            "telephone_number": "252-792-1071",
            "fax_number": "252-792-1071"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "307 S MCCASKEY RD",
            "city": "WILLIAMSTON",
            "state": "NC",
            "postal_code": "27892",
            "telephone_number": "252-792-1071",
            "fax_number": "252-792-1071"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHUNG",
        "first_name": "WAN",
        "middle_name": "SOO",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-05",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NC",
            "license": "21923",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "22478",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8922478",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jeffrey Jerome Caldwell Sr., D.D.S.
• Cardiac Wellness Imaging, PLLC
• Cardiac Wellness Specialists, P.a.
• Carl Thomas Dover Jr
• Centennial Housing & Community Services Corporation
• Clarks Home Medical Equipment, Inc
• Community Home Care Inc.
• Comprehensive Interventions Inc
• Comprehensive Interventions Inc
• Comprehensive Interventions, Inc.

• All providers in Williamston, NC
• Family Medicine Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.