MEDICARE: DR. KYUNG WHAN NOH M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RG0100X	Gastroenterology Physician	ME87335	FL
2	207RG0100X	Gastroenterology Physician	MD00045918	WA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	P00046481	OTHER	FL	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	78731	OTHER	FL	BLUECROSS/BLUESHIELD
2	0285235	OTHER	WA	STATE L&I
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1417930454
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KYUNG WHAN NOH M.D.

Provider Business Mailing Address
First Line	:	4700 PT FSDICK DR NW STE 300
Second Line	:
City	:	GIG HARBOR
State	:	WA
Zip	:	98335-1706
Country	:	US
Telephone Number	:	253-858-5433
Fax Number	:	253-272-0419

Provider Business Practice Location Address
First Line	:	4700 PT FSDICK DR NW STE 300
Second Line	:
City	:	GIG HARBOR
State	:	WA
Zip	:	98335-1706
Country	:	US
Telephone Number	:	253-858-5433
Fax Number	:	253-272-0419

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/23/2005
Last Update Date	:	12/08/2020

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Directions to “ DR. KYUNG WHAN NOH M.D.” Practice Location

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