Chung Chun Chan, M.D.

Primary specialty

SpecialistTaxonomy code 174400000X

License

12991 Issued in WA

Practice address

3526 Olympic Blvd W
University Place, WA 98466-1408

Phone

(253) 565-6679

NPI assigned

Jun 16, 2006

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Pacific Vascular Incorporated

  • Physiological Laboratory
  • Port Ludlow, WA
  • NPI 1336019314
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1150416000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1972547123",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3526 OLYMPIC BLVD W",
            "city": "UNIVERSITY PLACE",
            "state": "WA",
            "postal_code": "984661408",
            "telephone_number": "253-565-6679"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3526 OLYMPIC BLVD W",
            "city": "UNIVERSITY PLACE",
            "state": "WA",
            "postal_code": "984661408",
            "telephone_number": "253-565-6679"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHAN",
        "first_name": "CHUNG",
        "middle_name": "CHUN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-16",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "WA",
            "license": "12991",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Leah Ceehorne, RN
• Brynn Cenicola, MA
• Calypso Cervantes
• Chambers Bay Internal Medicine
• Jennifer Lorene Champion, DNC, MS,CNS, CN, DCN
• Sahara Chandler
• Ray Chang, M.D.
• Hannah Chase
• Alyssa Cheesman
• Cheiryl Legaspi LLC (Triumph Dental)

• Specialist in University Place, WA
• Providers in University Place, WA by specialty
• Specialist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.