Basic Information
| Provider Information | |||||||||
| NPI: | 1609854926 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHONG | ||||||||
| FirstName: | DANIEL | ||||||||
| MiddleName: | HYUN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DDS | ||||||||
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| Mailing Information | |||||||||
| Address1: | LINCOLN ST 2ND FLOOR BLDG 9900 | ||||||||
| Address2: | USA DENTAC | ||||||||
| City: | TACOMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 98431 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2539684039 | ||||||||
| FaxNumber: | 2539684039 | ||||||||
| Practice Location | |||||||||
| Address1: | LINCOLN ST 2ND FLOOR, BLDG 9900 | ||||||||
| Address2: | USA DENTAC | ||||||||
| City: | TACOMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 98431 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2539684039 | ||||||||
| FaxNumber: | 2539684039 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/06/2006 | ||||||||
| LastUpdateDate: | 06/17/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | DE00010313 | WA | Y | Dental Providers | Dentist | 1223P0700X | DE00010313 | WA | N | Dental Providers | Dentist | Prosthodontics | 1223P0700X | DT2206 | HI | N | Dental Providers | Dentist | Prosthodontics |
No ID Information.