Healthcare Provider Details

I. General information

NPI: 1942055215
Provider Name (Legal Business Name): JOANNE CHUNG PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2024
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date: 10/29/2024
Reactivation Date: 11/07/2024

III. Provider practice location address

4410 106TH ST SW
MUKILTEO WA
98275-4700
US

IV. Provider business mailing address

7600 EVERGREEN WAY
EVERETT WA
98203-6421
US

V. Phone/Fax

Practice location:
  • Phone: 425-259-0966
  • Fax:
Mailing address:
  • Phone: 206-860-5414
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA61625423
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: