Provider Demographics
NPI:1811047947
Name:CHUNG, TIMOTHY (MD)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:
Last Name:CHUNG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3797
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-3797
Mailing Address - Country:US
Mailing Address - Phone:253-627-1244
Mailing Address - Fax:253-627-3520
Practice Address - Street 1:1802 YAKIMA AVE
Practice Address - Street 2:SUITE 302
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-4499
Practice Address - Country:US
Practice Address - Phone:253-627-1244
Practice Address - Fax:253-627-3520
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00017693174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1800CHOtherREGENCE
WAP00143778OtherRAILROAD MEDICARE
WA1707CHOtherREGENCE
WA1527308Medicaid
WA0177826OtherDEPARTMENT OF L&I
WA1300CHOtherREGENCE
WA1802CHOtherREGENCE
WA4723CHOtherREGENCE
WAB18257Medicare UPIN
WA8802259Medicare ID - Type UnspecifiedMEDICARE