Healthcare Provider Details

I. General information

NPI: 1912054859
Provider Name (Legal Business Name): JENNIFER L HOOCK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2007
Last Update Date: 01/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3915 TALBOT RD S STE 401
RENTON WA
98055-5738
US

IV. Provider business mailing address

3600 LIND AVE SW STE 100
RENTON WA
98057-4934
US

V. Phone/Fax

Practice location:
  • Phone: 425-656-4224
  • Fax: 425-656-4099
Mailing address:
  • Phone: 425-656-5412
  • Fax: 425-656-4079

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD00028847
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: