Healthcare Provider Details

I. General information

NPI: 1861486367
Provider Name (Legal Business Name): CHAN SUN HWANG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/12/2005
Last Update Date: 11/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9312 S TACOMA WAY STE 115
LAKEWOOD WA
98499-4474
US

IV. Provider business mailing address

6820 WATER ST NE
TACOMA WA
98422-1056
US

V. Phone/Fax

Practice location:
  • Phone: 253-251-2551
  • Fax: 253-251-3197
Mailing address:
  • Phone: 253-732-3564
  • Fax: 877-425-1425

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081N0008X
TaxonomyNeuromuscular Medicine (Physical Medicine & Rehabilitation) Physician
License Number00035834
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License NumberMD00035834
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: