Provider Demographics
NPI: | 1508957903 |
---|---|
Name: | HWANG, JOSEPH K (MD) |
Entity Type: | Individual |
Prefix: | |
First Name: | JOSEPH |
Middle Name: | K |
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: | 1608 S J ST FL 1 |
Mailing Address - Street 2: | |
Mailing Address - City: | TACOMA |
Mailing Address - State: | WA |
Mailing Address - Zip Code: | 98405-4930 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 253-428-2100 |
Mailing Address - Fax: | 253-274-7563 |
Practice Address - Street 1: | 1608 S J ST |
Practice Address - Street 2: | |
Practice Address - City: | TACOMA |
Practice Address - State: | WA |
Practice Address - Zip Code: | 98405-4930 |
Practice Address - Country: | US |
Practice Address - Phone: | 253-428-2100 |
Practice Address - Fax: | 253-274-7563 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2006-09-28 |
Last Update Date: | 2023-03-06 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
WA | MD60568419 | 207V00000X, 207VM0101X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 207VM0101X | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Maternal & Fetal Medicine |
No | 207V00000X | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
WA | 2047039 | Medicaid | |
WA | 1508957903 | Medicaid | |
IA | 1532911 | Medicaid | |
IA | 36603 | Other | WELLMARK |