Provider Demographics
NPI:1609600410
Name:CHEA, JEFFERSON LENGHONG (EMT)
Entity type:Individual
Prefix:
First Name:JEFFERSON
Middle Name:LENGHONG
Last Name:CHEA
Suffix:
Gender:M
Credentials:EMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15560 WESTMINSTER WAY N APT 514
Mailing Address - Street 2:
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98133-5942
Mailing Address - Country:US
Mailing Address - Phone:206-902-0568
Mailing Address - Fax:
Practice Address - Street 1:18821 E VALLEY HWY
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98032-1219
Practice Address - Country:US
Practice Address - Phone:206-988-5000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-26
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61486696146N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic