Healthcare Provider Details

I. General information

NPI: 1154232007
Provider Name (Legal Business Name): HAN BAO DANG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33702 21ST AVE SW
FEDERAL WAY WA
98023-7780
US

IV. Provider business mailing address

33702 21ST AVE SW
FEDERAL WAY WA
98023-7780
US

V. Phone/Fax

Practice location:
  • Phone: 253-952-0133
  • Fax: 253-952-0142
Mailing address:
  • Phone: 253-952-0133
  • Fax: 253-952-0142

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPHRM.PH.70015619
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: