MEDICARE: DR. MICHELLE S. CHUNG DMD

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
1	1223P0221X	Pediatric Dentistry	DT 2478	HI
2	1223P0221X	Pediatric Dentistry	DE61645658	WA

General Provider Information

NPI Number	:	1902152713
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHELLE S. CHUNG DMD

Provider Business Mailing Address
First Line	:	16810 MERIDIAN E UNIT J104
Second Line	:
City	:	PUYALLUP
State	:	WA
Zip	:	98375-9604
Country	:	US
Telephone Number	:	253-848-5437
Fax Number	:

Provider Business Practice Location Address
First Line	:	16810 MERIDIAN E UNIT J104
Second Line	:
City	:	PUYALLUP
State	:	WA
Zip	:	98375-9604
Country	:	US
Telephone Number	:	253-848-5437
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/30/2012
Last Update Date	:	03/11/2025

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