Basic Information
| Provider Information | |||||||||
| NPI: | 1780744193 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHAE | ||||||||
| FirstName: | SEUNG | ||||||||
| MiddleName: | E | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2101 E JEFFERSON ST | ||||||||
| Address2: | KAISER PERMANENTE MEDICARE ENROLLMENT | ||||||||
| City: | ROCKVILLE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 208524908 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3018162424 | ||||||||
| FaxNumber: | 4148745012 | ||||||||
| Practice Location | |||||||||
| Address1: | 10701 ROSEMARY DR | ||||||||
| Address2: | |||||||||
| City: | MANASSAS | ||||||||
| State: | VA | ||||||||
| PostalCode: | 201097282 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7032573000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/08/2006 | ||||||||
| LastUpdateDate: | 02/07/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/07/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 39565 020 | WI | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | D0072943 | MD | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 0101243749 | VA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.