=====================================================
General NPI Number Information
=====================================================
NPI Number | 1508087693
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PHILIP C. KIERNEY M.D. P.S
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/02/2007
-----------------------------------------------------
Last Update Date | 02/03/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 105 27TH AVE SE
-----------------------------------------------------
City | PUYALLUP
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98374-1150
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 253-848-8110
-----------------------------------------------------
Fax | 253-845-3561
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 105 27TH AVE SE
-----------------------------------------------------
City | PUYALLUP
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98374-1150
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 253-848-8110
-----------------------------------------------------
Fax | 253-845-3561
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. CHIA CHUNG
-----------------------------------------------------
Credential | MD,PS
-----------------------------------------------------
Telephone | 253-848-8110
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | 601000983
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------