MEDICARE: DAVID CHONG DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	DE60772685	WA

General Provider Information

NPI Number	:	1609390350
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID CHONG DDS

Provider Business Mailing Address
First Line	:	1959 NE PACIFIC ST
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98195-0001
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1000 UNION AVE SE STE 101
Second Line	:
City	:	OLYMPIA
State	:	WA
Zip	:	98501-1589
Country	:	US
Telephone Number	:	360-357-5290
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/02/2017
Last Update Date	:	07/17/2020

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Directions to “ DAVID CHONG DDS” Practice Location

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