1497759302 NPI number — ANDREW S HWANG M.D.,

Table of content: ANDREW S HWANG M.D., (NPI 1497759302)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497759302 NPI number — ANDREW S HWANG M.D.,

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HWANG
Provider First Name:
ANDREW
Provider Middle Name:
S
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.,
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1497759302
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
03/25/2006
NPI Reactivation Date:
04/06/2006

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2201 S 19TH ST
Provider Second Line Business Mailing Address:
STE 201
Provider Business Mailing Address City Name:
TACOMA
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98405-2961
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
253-627-8680
Provider Business Mailing Address Fax Number:
253-627-2542

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2201 S 19TH ST
Provider Second Line Business Practice Location Address:
STE 201
Provider Business Practice Location Address City Name:
TACOMA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98405-2961
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-627-8680
Provider Business Practice Location Address Fax Number:
253-627-2542
Provider Enumeration Date:
06/08/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  27252 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 802525 . This is a "SSI" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 1057066 . This is a "DSHS" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 52649 . This is a "L&I ID" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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