Healthcare Provider Details

I. General information

NPI: 1487928099
Provider Name (Legal Business Name): CHAN S HWANG, MD, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2012
Last Update Date: 02/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

126 15TH ST SE
PUYALLUP WA
98372-3409
US

IV. Provider business mailing address

126 15TH ST SE
PUYALLUP WA
98372-3409
US

V. Phone/Fax

Practice location:
  • Phone: 253-229-0580
  • Fax:
Mailing address:
  • Phone: 253-229-0580
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License NumberMD00035834
License Number StateWA

VIII. Authorized Official

Name: DR. CHAN S HWANG
Title or Position: PHYSICIAN MANAGER
Credential: M.D.
Phone: 253-229-0580