Healthcare Provider Details

I. General information

NPI: 1083087290
Provider Name (Legal Business Name): JESSICA UYEN HUA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2015
Last Update Date: 11/04/2022
Certification Date: 11/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3915 TALBOT RD S STE 300
RENTON WA
98055-5738
US

IV. Provider business mailing address

3915 TALBOT RD S STE 300
RENTON WA
98055-5738
US

V. Phone/Fax

Practice location:
  • Phone: 425-690-3409
  • Fax: 425-690-9005
Mailing address:
  • Phone: 425-690-3409
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH60876942
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: