Provider Demographics
NPI:1083087290
Name:HUA, JESSICA UYEN
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:UYEN
Last Name:HUA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3915 TALBOT RD S STE 300
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98055-5738
Mailing Address - Country:US
Mailing Address - Phone:425-690-3409
Mailing Address - Fax:
Practice Address - Street 1:3915 TALBOT RD S STE 300
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98055-5738
Practice Address - Country:US
Practice Address - Phone:425-690-3409
Practice Address - Fax:425-690-9005
Is Sole Proprietor?:No
Enumeration Date:2015-11-10
Last Update Date:2022-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH60876942183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist