Healthcare Provider Details

I. General information

NPI: 1730576794
Provider Name (Legal Business Name): KIHYUK ROY JUNG D.C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/16/2015
Last Update Date: 03/27/2020
Certification Date: 03/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13751 LAKE CITY WAY NE STE 310
SEATTLE WA
98125-8631
US

IV. Provider business mailing address

12311 32ND AVE NE APT 409
SEATTLE WA
98125-5599
US

V. Phone/Fax

Practice location:
  • Phone: 425-954-6524
  • Fax: 206-962-4999
Mailing address:
  • Phone: 206-293-5508
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License NumberCH60539446
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH60539446
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: