Provider Demographics
NPI:1437921475
Name:CHUNG, DANIEL INSOO
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:INSOO
Last Name:CHUNG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11065 PACIFIC CREST PL NW STE B105
Mailing Address - Street 2:
Mailing Address - City:SILVERDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98383-6607
Mailing Address - Country:US
Mailing Address - Phone:360-261-6154
Mailing Address - Fax:
Practice Address - Street 1:11065 PACIFIC CREST PL NW STE B105
Practice Address - Street 2:
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98383-6607
Practice Address - Country:US
Practice Address - Phone:360-261-6154
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-24
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE61463784122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist