Provider Demographics
NPI:1912010984
Name:KITSAP GENERAL SURGERY PLLC
Entity Type:Organization
Organization Name:KITSAP GENERAL SURGERY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIANPARTNER
Authorized Official - Prefix:
Authorized Official - First Name:TY
Authorized Official - Middle Name:
Authorized Official - Last Name:CHUN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:360-613-1335
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-16
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7134984Medicaid
WAG8862524Medicare PIN