Peter Dongil Chung, PA-C
Individual provider Active NPI Physician Assistant · Hanover, MD
NPI 1992952170 · NPPES record last updated Dec 21, 2022
Key facts
- NPI
- 1992952170
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- 58763 (CA)
- Practice address
- 6311 Mary Theresa CT
Hanover, MD 21076-1028 - Phone
- (302) 430-1974
- NPI assigned
- Aug 19, 2008
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 9
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in MD, CA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20111020000326 | MD | Practitioner - Physician Assistant | 1456400910 | Reassigns benefits to 2 organizations |
| I20220119003091 | CA | Practitioner - Physician Assistant | 1456400910 | Reassigns benefits to 3 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 58763 | CA | MD | Pharmacist |
| C5-0000606 | DE | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Coastline Medical Walk in Center | Current | Accepting new patients | |
| Northwest Hospital Center, Inc | Physician Assistant | Current |
Accepting new patients |
| Lifebridge Community Physicians Inc | Current |
Accepting new patients | |
| Minghsun Liu, M.D., PC | Current |
Accepting new patients | |
| WT Health of California LLC | Current |
Accepting new patients | |
| Lifebridge Community Physicians, Inc. | Current |
Accepting new patients | |
| Pacific Professional Surgical Group Inc | Past | Accepting new patients |
Locations
11103 Venice Blvd
Los Angeles, CA 90034
Phone (310) 734-8526
907 N DuPont Blvd
Ste 102
Milford, DE 19963
Phone (302) 265-2893
200 S Park Rd
Ste 200
Hollywood, FL 33021
Phone (866) 986-2263
2000 W Baltimore St
Baltimore, MD 21223
Phone (410) 362-3075
5401 Old Court Rd
Randallstown, MD 21133
Phone (301) 337-2727
410 Malcolm Dr
Ste A
Westminster, MD 21157
Phone (410) 876-1633
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | C5-0000606 | DE | |
| Physician Assistant | 363A00000X | 58763 | CA | Yes |
Addresses
Primary practice location
6311 Mary Theresa CT
Hanover, MD 21076-1028
Mailing address
6311 Mary Theresa CT
Hanover, MD 21076-0000
Phone (302) 430-1974
Other providers in Hanover, MD
- Chesapeake Orthopaedic & Sports Medicine Center
- Chesapeake Orthopaedic and Sports Medicine Center
- Chesapeake Urology Associates, LLC
- Gareth Leku Chia
- Brandon Chie
- Rebecca Rodriguez Cirri
- Paul Robert Clavelle
- Clinical Counseling Services, LLC
- Carla Cobbs
- Kathleen A Coggins
All providers in Hanover, MD · Physician Assistant in Maryland
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 21, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.