Healthcare Provider Details

I. General information

NPI: 1376839944
Provider Name (Legal Business Name): MATTHEW ENKYUM JUNG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2011
Last Update Date: 03/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

128 LILLY RD NE STE 202
OLYMPIA WA
98506
US

IV. Provider business mailing address

128 LILLY RD NE STE 202
OLYMPIA WA
98506-7400
US

V. Phone/Fax

Practice location:
  • Phone: 360-357-6314
  • Fax:
Mailing address:
  • Phone: 360-357-6314
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number2011015922
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number60892789
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: