Provider Demographics
NPI:1417169277
Name:HOANG, KATHERINE (MD)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:HOANG
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 1:4550 FAUNTLEROY WAY SW STE 100
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98126-3471
Mailing Address - Country:US
Mailing Address - Phone:206-933-1041
Mailing Address - Fax:253-426-6344
Practice Address - Street 1:4550 FAUNTLEROY WAY SW
Practice Address - Street 2:SUITE 100
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98126-2740
Practice Address - Country:US
Practice Address - Phone:206-933-1041
Practice Address - Fax:206-933-1047
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2020-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAML20007828207Q00000X
WAMD00048260207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1057046Medicaid