Provider Demographics
NPI:1215407770
Name:HUANG, MONICA (PA-C)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:
Last Name:HUANG
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7308 BRIDGEPORT WAY W STE 201
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98499-8000
Mailing Address - Country:US
Mailing Address - Phone:253-582-7257
Mailing Address - Fax:253-582-1617
Practice Address - Street 1:1724 W UNION AVE STE 100
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-2099
Practice Address - Country:US
Practice Address - Phone:253-830-5200
Practice Address - Fax:537-521-1602
Is Sole Proprietor?:No
Enumeration Date:2018-11-27
Last Update Date:2019-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA60916742363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2118633Medicaid