Provider Demographics
NPI:1477961738
Name:CHA, JENNA JOOHYUN (DDS, MS)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:JOOHYUN
Last Name:CHA
Suffix:
Gender:F
Credentials:DDS, MS
Other - Prefix:
Other - First Name:JENNA
Other - Middle Name:
Other - Last Name:CHA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2505 S 320TH ST STE 330
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-5461
Mailing Address - Country:US
Mailing Address - Phone:206-400-0800
Mailing Address - Fax:
Practice Address - Street 1:2505 S 320TH ST STE 330
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-5461
Practice Address - Country:US
Practice Address - Phone:206-400-0800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-30
Last Update Date:2021-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1014641223P0300X
WADE611272161223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics