Healthcare Provider Details

I. General information

NPI: 1609392083
Provider Name (Legal Business Name): HWANG-BOTHELL PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2017
Last Update Date: 07/21/2022
Certification Date: 12/19/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17917 BOTHELL EVERETT HWY STE 305
BOTHELL WA
98012-6379
US

IV. Provider business mailing address

17917 BOTHELL EVERETT HWY STE 305
BOTHELL WA
98012-6379
US

V. Phone/Fax

Practice location:
  • Phone: 425-481-1038
  • Fax: 425-483-3158
Mailing address:
  • Phone: 425-481-1038
  • Fax: 425-483-3158

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License NumberDE00009254
License Number StateWA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DAVID Y HWANG
Title or Position: MANAGER
Credential:
Phone: 425-641-5140