Provider Demographics
NPI:1326098658
Name:HAGUE, MIYOUNG C (DDS)
Entity Type:Individual
Prefix:
First Name:MIYOUNG
Middle Name:C
Last Name:HAGUE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:MI
Other - Middle Name:Y
Other - Last Name:CHANG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:PO BOX 3835
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-3835
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1200 12TH AVE S
Practice Address - Street 2:SUITE 901
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98144-2712
Practice Address - Country:US
Practice Address - Phone:206-548-3114
Practice Address - Fax:206-762-6355
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2016-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE00009430122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5046982Medicaid
WABC7991599OtherDEA