Chung, Willis Clement
Chung, Willis Clement is an individual health care provider with primary practice located at 7595 Anagram Dr , Eden Prairie MN 55344-7399. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Diagnostic Radiology, Allopathic & Osteopathic Physicians / Neuroradiology. Allopathic & Osteopathic Physicians / Neuroradiology is his primary health care specialty. Chung, Willis Clement can be contacted via phone (612) 573-2200.Contact Information
Primary practice address
7595 Anagram Dr
Eden Prairie MN 55344-7399
Phone: (612) 573-2200
Fax: (612) 573-2274
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Diagnostic Radiology | 2085R0202X | P3700 | Texas |
| Allopathic & Osteopathic Physicians / Diagnostic Radiology | 2085R0202X | 33420 | Colorado |
| Allopathic & Osteopathic Physicians / Neuroradiology | 2085N0700X | 64006 | Minnesota |
Profile Details
| NPI number | 1659357804 |
|---|---|
| LBN Legal business name | Chung, Willis Clement |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Dec 20th, 2005 |
| Last updated | Jul 13th, 2022 - about 2 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1659357804 | NPPES |
| Colorado | Other | P00031103 | RR MCRE RIA |
| Colorado | Other | P00002241 | RR MCRE RIA |
| Colorado | Other | 1659357804 | RR MCRE RIA |
| Colorado | MEDICAID | 01334200 | RR MCRE RIA |
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