Healthcare Provider Details

I. General information

NPI: 1104357854
Provider Name (Legal Business Name): ANNIE SHIQIONG HONG M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHIQIONG HONG M.D.

II. Dates (important events)

Enumeration Date: 03/24/2017
Last Update Date: 08/02/2023
Certification Date: 08/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1135 116TH AVE NE STE 560
BELLEVUE WA
98004-4631
US

IV. Provider business mailing address

1701 W CHARLESTON BLVD #230
LAS VEGAS NV
89102-2325
US

V. Phone/Fax

Practice location:
  • Phone: 425-454-4768
  • Fax: 425-462-8021
Mailing address:
  • Phone: 702-671-2341
  • Fax: 702-671-2376

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberMD61390418
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: