Provider Demographics
NPI:1447034541
Name:CHUA, MELINA LICONG
Entity type:Individual
Prefix:
First Name:MELINA
Middle Name:LICONG
Last Name:CHUA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16529 8TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98155-5011
Mailing Address - Country:US
Mailing Address - Phone:206-832-6988
Mailing Address - Fax:425-967-5181
Practice Address - Street 1:6005 183RD ST SW
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98037-7228
Practice Address - Country:US
Practice Address - Phone:206-832-6988
Practice Address - Fax:425-967-5181
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-21
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA753429376G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376G00000XNursing Service Related ProvidersNursing Home AdministratorGroup - Single Specialty