Healthcare Provider Details

I. General information

NPI: 1497759302
Provider Name (Legal Business Name): ANDREW S HWANG M.D.,
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/08/2005
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date: 03/25/2006
Reactivation Date: 04/06/2006

III. Provider practice location address

2201 S 19TH ST STE 201
TACOMA WA
98405-2961
US

IV. Provider business mailing address

2201 S 19TH ST STE 201
TACOMA WA
98405-2961
US

V. Phone/Fax

Practice location:
  • Phone: 253-627-8680
  • Fax: 253-627-2542
Mailing address:
  • Phone: 253-627-8680
  • Fax: 253-627-2542

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number27252
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: