Provider Demographics
NPI:1306953617
Name:CHUNG, PAUL Y (MD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:Y
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 1506
Mailing Address - Street 2:
Mailing Address - City:CHEHALIS
Mailing Address - State:WA
Mailing Address - Zip Code:98532-0409
Mailing Address - Country:US
Mailing Address - Phone:360-242-3008
Mailing Address - Fax:360-807-7687
Practice Address - Street 1:2517 NE KRESKY AVE
Practice Address - Street 2:
Practice Address - City:CHEHALIS
Practice Address - State:WA
Practice Address - Zip Code:98532-2409
Practice Address - Country:US
Practice Address - Phone:360-748-8632
Practice Address - Fax:360-748-3869
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00040172207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1007352Medicaid
ID1306953617Medicaid
WA180043031OtherRAIL ROAD MEDICARE
AK1571850Medicaid
WA180043029OtherRAIL ROAD MEDICARE
ID180043539OtherRAIL ROAD MEDICARE
MT180044162OtherRAIL ROAD MEDICARE MT
MT0047821Medicaid
OR268679Medicaid
WA180043030OtherRAIL ROAD MEDICARE
OR180043540OtherRAIL ROAD MEDICARE OR
ID180043539OtherRAIL ROAD MEDICARE
F45381Medicare UPIN
WAGAB23471Medicare PIN
WAGAB23476Medicare PIN
ORR111244Medicare PIN