Healthcare Provider Details

I. General information

NPI: 1609229699
Provider Name (Legal Business Name): ALBERT CHUNG DENTAL CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2016
Last Update Date: 07/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12715 BEL RED RD STE 201
BELLEVUE WA
98005-2627
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 Number
License Number State

VIII. Authorized Official

Name: DR. KWOK HUNG CHUNG
Title or Position: MANAGER
Credential: DDS
Phone: 206-265-2616