Healthcare Provider Details

I. General information

NPI: 1497239966
Provider Name (Legal Business Name): YOUNG RYEOL CHUN MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LYDIA CHUN LICSW

II. Dates (important events)

Enumeration Date: 09/20/2018
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16300 MILL CREEK BLVD STE 208
MILL CREEK WA
98012-1279
US

IV. Provider business mailing address

16300 MILL CREEK BLVD STE 208
MILL CREEK WA
98012-1279
US

V. Phone/Fax

Practice location:
  • Phone: 425-610-6533
  • Fax:
Mailing address:
  • Phone: 425-610-6533
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLW61192171
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: