Individual
DR. WILLIS CLEMENT CHUNG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
7595 ANAGRAM DR, EDEN PRAIRIE, MN 55344-7399
(612) 573-2200
(612) 573-2274
Mailing address
7595 ANAGRAM DR, EDEN PRAIRIE, MN 55344-7399
(612) 573-2200
(612) 573-2274
Taxonomy
Speciality
Code
Description
License number
State
2085N0700X
Neuroradiology Physician
Primary
64006
MN
2085R0202X
Diagnostic Radiology Physician
33420
CO
2085R0202X
Diagnostic Radiology Physician
P3700
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01334200
—
CO
01
—
1659357804
WY MEDICAID
WY
01
—
P00002241
RR MCRE MIC
CO
01
—
P00031103
RR MCRE RIA
CO
Enumeration date
12/20/2005
Last updated
01/08/2025
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