Healthcare Provider Details

I. General information

NPI: 1891945010
Provider Name (Legal Business Name): GLEN P HUNG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/24/2008
Last Update Date: 09/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

68 CASCADE KEY
BELLEVUE WA
98006-1030
US

IV. Provider business mailing address

68 CASCADE KEY
BELLEVUE WA
98006-1030
US

V. Phone/Fax

Practice location:
  • Phone: 425-641-2611
  • Fax: 425-641-2620
Mailing address:
  • Phone: 425-641-2611
  • Fax: 425-641-2620

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD00014854
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: