Provider Demographics
NPI:1487928099
Name:CHAN S HWANG, MD, PLLC
Entity type:Organization
Organization Name:CHAN S HWANG, MD, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHAN
Authorized Official - Middle Name:S
Authorized Official - Last Name:HWANG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:253-229-0580
Mailing Address - Street 1:126 15TH ST SE
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98372-3409
Mailing Address - Country:US
Mailing Address - Phone:253-229-0580
Mailing Address - Fax:
Practice Address - Street 1:126 15TH ST SE
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98372-3409
Practice Address - Country:US
Practice Address - Phone:253-229-0580
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-28
Last Update Date:2012-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00035834261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0150123OtherDEPARTMENT OF LABOR AND INDUSTRIES
WA1114321Medicaid
WA0150123OtherDEPARTMENT OF LABOR AND INDUSTRIES
WAAB26252Medicare Oscar/Certification