=====================================================
General NPI Number Information
=====================================================
NPI Number | 1609854926
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DANIEL HYUN CHONG DDS
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/06/2006
-----------------------------------------------------
Last Update Date | 06/06/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 33301 9TH AVE S STE 125
-----------------------------------------------------
City | FEDERAL WAY
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98003-2600
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 253-946-6361
-----------------------------------------------------
Fax | 253-838-1750
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 33301 9TH AVE S STE 125
-----------------------------------------------------
City | FEDERAL WAY
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98003-2600
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 253-946-6361
-----------------------------------------------------
Fax | 253-838-1750
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223P0700X
-----------------------------------------------------
Taxonomy Name | Prosthodontics
-----------------------------------------------------
License Number | DT2206
-----------------------------------------------------
License Number State | HI
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | DE00010313
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 1223P0700X
-----------------------------------------------------
Taxonomy Name | Prosthodontics
-----------------------------------------------------
License Number | DE00010313
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------