Provider Demographics
NPI:1659484699
Name:CHUN, TY (MD)
Entity Type:Individual
Prefix:
First Name:TY
Middle Name:
Last Name:CHUN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
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Mailing Address - Street 1:9927 MICKELBERRY RD NW
Mailing Address - Street 2:SUITE 121
Mailing Address - City:SILVERDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98383-9195
Mailing Address - Country:US
Mailing Address - Phone:360-613-1335
Mailing Address - Fax:360-613-1329
Practice Address - Street 1:9927 MICKELBERRY RD NW
Practice Address - Street 2:SUITE 121
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98383-9195
Practice Address - Country:US
Practice Address - Phone:360-613-1335
Practice Address - Fax:360-613-1329
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2012-11-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WAMD00028608208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8466658Medicaid
WA8466658Medicaid
WAG8862615Medicare PIN