Healthcare Provider Details

I. General information

NPI: 1245595669
Provider Name (Legal Business Name): PEANUT WAI-PING WONG HATTAWAY DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2012
Last Update Date: 06/05/2025
Certification Date: 06/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16255 NE 87TH ST STE 150
REDMOND WA
98052-7464
US

IV. Provider business mailing address

955 POWELL AVE SW
RENTON WA
98057-2908
US

V. Phone/Fax

Practice location:
  • Phone: 425-883-8000
  • Fax: 425-883-7580
Mailing address:
  • Phone: 425-277-1311
  • Fax: 425-277-1566

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDE60284417
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number60284417
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: