Provider Demographics
NPI:1376881748
Name:CHONG, AMY W (EAMP, LAC)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:W
Last Name:CHONG
Suffix:
Gender:F
Credentials:EAMP, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20028 15TH AVE NE, UNIT 210
Mailing Address - Street 2:
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98155
Mailing Address - Country:US
Mailing Address - Phone:424-625-5405
Mailing Address - Fax:
Practice Address - Street 1:1603 116TH AVE NE STE 111
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004
Practice Address - Country:US
Practice Address - Phone:424-625-5405
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-20
Last Update Date:2018-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC 60312915171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist