Provider Demographics
NPI:1851826184
Name:CHUNG, SAMANTHA SEUNGWON (MD)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:SEUNGWON
Last Name:CHUNG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16233 SYLVESTER RD SW STE G20
Mailing Address - Street 2:
Mailing Address - City:BURIEN
Mailing Address - State:WA
Mailing Address - Zip Code:98166-3070
Mailing Address - Country:US
Mailing Address - Phone:206-431-9771
Mailing Address - Fax:206-431-5484
Practice Address - Street 1:16233 SYLVESTER RD SW STE G20
Practice Address - Street 2:
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98166-3070
Practice Address - Country:US
Practice Address - Phone:206-431-9771
Practice Address - Fax:206-431-5484
Is Sole Proprietor?:No
Enumeration Date:2017-04-24
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD6137789207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2271883Medicaid