Provider Demographics
NPI:1245595669
Name:HATTAWAY, PEANUT WAI-PING WONG (DMD)
Entity Type:Individual
Prefix:DR
First Name:PEANUT
Middle Name:WAI-PING WONG
Last Name:HATTAWAY
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15837 NE91ST WAY
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052-7515
Mailing Address - Country:US
Mailing Address - Phone:425-202-5151
Mailing Address - Fax:
Practice Address - Street 1:19820 SCRIBER LAKE RD
Practice Address - Street 2:SUITE #2
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-6121
Practice Address - Country:US
Practice Address - Phone:206-363-4105
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-11
Last Update Date:2016-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA602844171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice