Healthcare Provider Details

I. General information

NPI: 1558552604
Provider Name (Legal Business Name): KWOK-HUNG (ALBERT) CHUNG DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2007
Last Update Date: 09/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 116TH AVE NE STE A
BELLEVUE WA
98004-3802
US

IV. Provider business mailing address

11749 EXETER AVE NE
SEATTLE WA
98125-5913
US

V. Phone/Fax

Practice location:
  • Phone: 206-265-2616
  • Fax:
Mailing address:
  • Phone: 206-265-2616
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License NumberDE00010467
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: