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NPI Code Detail

MEDICARE: DR. JASON JAEHOON CHUNG O.D

MEDICARE: DR. JASON JAEHOON CHUNG O.D
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1152W00000XOptometristOD00003954WA

General Provider Information

NPI Number : 1508976168
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JASON JAEHOON CHUNG O.D
Provider Business Mailing Address
First Line : 1426 232ND AVENUE SE
Second Line :
City : SAMMAMISH
State : WA
Zip : 98075
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1201 39TH AVE SW
Second Line :
City : PUYALLUP
State : WA
Zip : 98373-3803
Country : US
Telephone Number : 425-392-6745
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/30/2006
Last Update Date : 07/08/2007

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