Provider Demographics
NPI:1104845668
Name:HUNG, JOHN C (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:C
Last Name:HUNG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1450 5TH ST SE
Mailing Address - Street 2:#4200
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98372-4602
Mailing Address - Country:US
Mailing Address - Phone:253-697-3450
Mailing Address - Fax:253-697-3470
Practice Address - Street 1:1450 5TH ST SE
Practice Address - Street 2:#4200
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98372-4602
Practice Address - Country:US
Practice Address - Phone:253-697-3450
Practice Address - Fax:253-697-3470
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2012-04-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WAMD00046263207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8865155Medicare PIN