Healthcare Provider Details

I. General information

NPI: 1598255903
Provider Name (Legal Business Name): SPORTS AND SPINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2018
Last Update Date: 05/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3900 FACTORIA BLVD SE STE A
BELLEVUE WA
98006-1234
US

IV. Provider business mailing address

PO BOX 827
BELLEVUE WA
98009-0827
US

V. Phone/Fax

Practice location:
  • Phone: 425-774-1538
  • Fax: 425-744-1527
Mailing address:
  • Phone: 425-774-1538
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: HYUN HONG
Title or Position: DOCTOR
Credential: MD
Phone: 425-774-1538