Healthcare Provider Details

I. General information

NPI: 1609337047
Provider Name (Legal Business Name): BENTON HUANG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2019
Last Update Date: 02/20/2023
Certification Date: 02/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2512 WHEATON WAY STE B
BREMERTON WA
98310-3303
US

IV. Provider business mailing address

2512 WHEATON WAY STE B
BREMERTON WA
98310-3303
US

V. Phone/Fax

Practice location:
  • Phone: 360-782-5826
  • Fax: 360-782-5899
Mailing address:
  • Phone: 360-782-5826
  • Fax: 360-782-5899

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD61153190
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: