Provider Demographics
NPI:1790886620
Name:HU, BENJAMIN T (MD)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:T
Last Name:HU
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 1:107 SOUTH MAIN STREET
Mailing Address - Street 2:SUITE D101
Mailing Address - City:COUPEVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98239-3547
Mailing Address - Country:US
Mailing Address - Phone:360-678-3456
Mailing Address - Fax:
Practice Address - Street 1:107 SOUTH MAIN STREET
Practice Address - Street 2:SUITE D101
Practice Address - City:COUPEVILLE
Practice Address - State:WA
Practice Address - Zip Code:98239-3547
Practice Address - Country:US
Practice Address - Phone:360-678-3456
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2009-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00024190208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1066075Medicaid
WA1066075Medicaid
WA1066075Medicaid
WAE98308Medicare UPIN