Active NPI
Matthew Kwang Joon Chung, DDS
- Dentist
- Vancouver, WA
National Provider Identifier
1740430842
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- DE60475502
- Practice address
- 14406 NE 20TH Ave
Vancouver, WA 98686-1448 - Phone
- (360) 571-3139
- NPI assigned
- Sep 25, 2008
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | DE60475502 | WA | Primary |
Addresses
Primary practice location
14406 NE 20TH Ave
Vancouver, WA 98686-1448
Mailing address
11900 NE 18TH St
Apt 470
Vancouver, WA 98684-4886
Phone (360) 433-5766
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DE60475502 | WA | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1222300800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1407801600000",
"number": "1740430842",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11900 NE 18TH ST",
"address_2": "APT 470",
"city": "VANCOUVER",
"state": "WA",
"postal_code": "986844886",
"telephone_number": "360-433-5766"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "14406 NE 20TH AVE",
"city": "VANCOUVER",
"state": "WA",
"postal_code": "986861448",
"telephone_number": "360-571-3139"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CHUNG",
"first_name": "MATTHEW",
"middle_name": "KWANG JOON",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-09-25",
"last_updated": "2014-08-12",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "WA",
"license": "DE60475502",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Vancouver, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.