Provider Demographics
NPI:1083803258
Name:HO, ROXANNE JUI (MD)
Entity Type:Individual
Prefix:
First Name:ROXANNE
Middle Name:JUI
Last Name:HO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 SW 27TH ST
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98057-2435
Mailing Address - Country:US
Mailing Address - Phone:206-630-1330
Mailing Address - Fax:
Practice Address - Street 1:2115 S 56TH ST STE 103
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98409-6900
Practice Address - Country:US
Practice Address - Phone:253-471-3193
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-23
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00048903207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1054607Medicaid
WA0283382OtherLABOR & INDUSTRIES (WORKER'S COMPENSATION)