Provider Demographics
NPI:1417930454
Name:NOH, KYUNG WHAN (MD)
Entity Type:Individual
Prefix:DR
First Name:KYUNG
Middle Name:WHAN
Last Name:NOH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4700 PT FSDICK DR NW STE 300
Mailing Address - Street 2:
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98335-1706
Mailing Address - Country:US
Mailing Address - Phone:253-858-5433
Mailing Address - Fax:253-272-0419
Practice Address - Street 1:4700 PT FSDICK DR NW STE 300
Practice Address - Street 2:
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98335-1706
Practice Address - Country:US
Practice Address - Phone:253-858-5433
Practice Address - Fax:253-272-0419
Is Sole Proprietor?:No
Enumeration Date:2005-11-23
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME87335207RG0100X
WAMD00045918207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL78731OtherBLUECROSS/BLUESHIELD
WA0285235OtherSTATE L&I
WA1009931Medicaid
FLP00046481OtherRAILROAD MEDICARE
FL78731OtherBLUECROSS/BLUESHIELD