Healthcare Provider Details

I. General information

NPI: 1083803258
Provider Name (Legal Business Name): ROXANNE JUI HO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2007
Last Update Date: 03/13/2023
Certification Date: 03/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2115 S 56TH ST STE 103
TACOMA WA
98409-6900
US

IV. Provider business mailing address

1300 SW 27TH ST
RENTON WA
98057-2435
US

V. Phone/Fax

Practice location:
  • Phone: 253-471-3193
  • Fax:
Mailing address:
  • Phone: 206-630-1330
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD00048903
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: