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General NPI Number Information
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NPI Number | 1033887443
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Entity Type | Individual
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Provider Name | TAYLOR KEIICHI CHONG PA-C
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Gender | Male
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Dates
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Enumeration Date | 08/31/2021
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Last Update Date | 09/25/2023
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Provider Practice Location Address
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Address Line | 5350 TALLMAN AVE NW STE 500
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City | SEATTLE
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State | WA
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Zip | 98107-5902
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Country | US
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Telephone | 206-784-8833
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Fax | 206-784-0676
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Provider Business Mailing Address
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Address Line | 2409 N 45TH ST
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City | SEATTLE
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State | WA
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Zip | 98103-6907
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Country | US
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Telephone | 206-633-8100
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Fax | 206-633-6107
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | PA61407244
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License Number State | WA
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