Healthcare Provider Details

I. General information

NPI: 1649537127
Provider Name (Legal Business Name): MYNGOC CHUNG SON PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2012
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2636 BELLEVUE WAY NE
BELLEVUE WA
98004-2209
US

IV. Provider business mailing address

2636 BELLEVUE WAY NE
BELLEVUE WA
98004-2209
US

V. Phone/Fax

Practice location:
  • Phone: 425-576-9222
  • Fax:
Mailing address:
  • Phone: 425-576-9222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number60217638
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberE18416
License Number StateID
# 3
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberPH60547410
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: