Provider Demographics
NPI:1902152713
Name:CHUNG, MICHELLE S (DMD)
Entity type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:S
Last Name:CHUNG
Suffix:
Gender:
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16810 MERIDIAN E UNIT J104
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98375-9604
Mailing Address - Country:US
Mailing Address - Phone:253-848-5437
Mailing Address - Fax:
Practice Address - Street 1:16810 MERIDIAN E UNIT J104
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98375-9604
Practice Address - Country:US
Practice Address - Phone:253-848-5437
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-30
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDT 24781223P0221X
WADE616456581223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry