Healthcare Provider Details

I. General information

NPI: 1780238741
Provider Name (Legal Business Name): CHIN CHUN PENG DDS, MSD, FACP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2019
Last Update Date: 12/12/2024
Certification Date: 12/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1959 NE PACIFIC STREET HEALTH AND SCIENCE CENTER D453
SEATTLE WA
98195-0001
US

IV. Provider business mailing address

1959 NE PACIFIC STREET HEALTH SCIENCES CENTER D770C
SEATTLE WA
98195-0001
US

V. Phone/Fax

Practice location:
  • Phone: 206-685-6812
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDE60830423
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License NumberDE60830423
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: