Provider Demographics
NPI:1609854926
Name:CHONG, DANIEL HYUN (DDS)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:HYUN
Last Name:CHONG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:LINCOLN ST 2ND FLOOR BLDG 9900
Mailing Address - Street 2:USA DENTAC
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98431
Mailing Address - Country:US
Mailing Address - Phone:253-968-4039
Mailing Address - Fax:253-968-4039
Practice Address - Street 1:LINCOLN ST 2ND FLOOR, BLDG 9900
Practice Address - Street 2:USA DENTAC
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98431
Practice Address - Country:US
Practice Address - Phone:253-968-4039
Practice Address - Fax:253-968-4039
Is Sole Proprietor?:No
Enumeration Date:2006-01-06
Last Update Date:2009-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE00010313122300000X, 1223P0700X
HIDT22061223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223P0700XDental ProvidersDentistProsthodontics