Healthcare Provider Details

I. General information

NPI: 1588341317
Provider Name (Legal Business Name): SANG YOON CHUNG DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: KYLE SANG YOON CHUNG DMD

II. Dates (important events)

Enumeration Date: 07/03/2023
Last Update Date: 07/03/2023
Certification Date: 07/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8012 112TH STREET CT E STE 320
PUYALLUP WA
98373-7856
US

IV. Provider business mailing address

50 UNIVERSITY ST APT 616
SEATTLE WA
98101-3253
US

V. Phone/Fax

Practice location:
  • Phone: 253-848-2331
  • Fax:
Mailing address:
  • Phone: 216-308-1846
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDE61449684
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: