Healthcare Provider Details

I. General information

NPI: 1447166657
Provider Name (Legal Business Name): TONY HANSEUNG CHUNG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2979 SQUALICUM PKWY FL 3
BELLINGHAM WA
98225-1811
US

IV. Provider business mailing address

2979 SQUALICUM PKWY FL 3
BELLINGHAM WA
98225-1811
US

V. Phone/Fax

Practice location:
  • Phone: 360-788-8200
  • Fax: 360-788-8329
Mailing address:
  • Phone: 360-788-8200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA.PA.70175537
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: