Healthcare Provider Details

I. General information

NPI: 1255331377
Provider Name (Legal Business Name): DENNIS CHONG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2005
Last Update Date: 02/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 17TH AVE WOUND HEALING CENTER
SEATTLE WA
98122-5711
US

IV. Provider business mailing address

3130 E MADISON ST STE 205
SEATTLE WA
98112-4264
US

V. Phone/Fax

Practice location:
  • Phone: 206-320-2580
  • Fax:
Mailing address:
  • Phone: 206-329-2393
  • Fax: 206-329-9614

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberMD00037549
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: