Provider Demographics
NPI:1609958586
Name:NG, JOSEPH WYHAM (DPM)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:WYHAM
Last Name:NG
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:WYHAM
Other - Middle Name:JOSEPH
Other - Last Name:NG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DPM
Mailing Address - Street 1:611 12TH AVE S
Mailing Address - Street 2:STE 200
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98144-1911
Mailing Address - Country:US
Mailing Address - Phone:206-324-9360
Mailing Address - Fax:
Practice Address - Street 1:611 12TH AVE S STE 200
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98144-1911
Practice Address - Country:US
Practice Address - Phone:206-324-9360
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAP000000319213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1297506Medicaid
WA71502OtherL & I
NG0036OtherREGENCE
WA71502OtherL & I
WA1297506Medicaid