Healthcare Provider Details

I. General information

NPI: 1609854926
Provider Name (Legal Business Name): DANIEL HYUN CHONG DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/06/2006
Last Update Date: 06/06/2024
Certification Date: 06/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33301 9TH AVE S STE 125
FEDERAL WAY WA
98003-2600
US

IV. Provider business mailing address

33301 9TH AVE S STE 125
FEDERAL WAY WA
98003-2600
US

V. Phone/Fax

Practice location:
  • Phone: 253-946-6361
  • Fax: 253-838-1750
Mailing address:
  • Phone: 253-946-6361
  • Fax: 253-838-1750

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License NumberDT2206
License Number StateHI
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDE00010313
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License NumberDE00010313
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: