Provider Demographics
NPI:1497759302
Name:HWANG, ANDREW S (MD,)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:S
Last Name:HWANG
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 1:2201 S 19TH ST
Mailing Address - Street 2:STE 201
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-2961
Mailing Address - Country:US
Mailing Address - Phone:253-627-8680
Mailing Address - Fax:253-627-2542
Practice Address - Street 1:2201 S 19TH ST
Practice Address - Street 2:STE 201
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-2961
Practice Address - Country:US
Practice Address - Phone:253-627-8680
Practice Address - Fax:253-627-2542
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-08
Last Update Date:2023-03-07
Deactivation Date:2006-03-25
Deactivation Code:
Reactivation Date:2006-04-06
Provider Licenses
StateLicense IDTaxonomies
WA27252174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA802525OtherSSI
WA1057066OtherDSHS
WA52649OtherL&I ID
WA52649OtherL&I ID
WA802525OtherSSI