Provider Demographics
NPI:1578688263
Name:HWAHN, KEN C (OD PS)
Entity Type:Individual
Prefix:
First Name:KEN
Middle Name:C
Last Name:HWAHN
Suffix:
Gender:M
Credentials:OD PS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:416 SOUTHCENTER MALL
Mailing Address - Street 2:
Mailing Address - City:TUKWILA
Mailing Address - State:WA
Mailing Address - Zip Code:98188-2811
Mailing Address - Country:US
Mailing Address - Phone:206-431-8770
Mailing Address - Fax:206-243-2027
Practice Address - Street 1:416 SOUTHCENTER MALL
Practice Address - Street 2:
Practice Address - City:TUKWILA
Practice Address - State:WA
Practice Address - Zip Code:98188-2811
Practice Address - Country:US
Practice Address - Phone:206-431-8770
Practice Address - Fax:206-243-2027
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2016-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD00001720152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2029392Medicaid
WA911535225OtherTAX ID #
WATO2923Medicare UPIN