Provider Demographics
NPI:1861486367
Name:HWANG, CHAN SUN (MD)
Entity Type:Individual
Prefix:
First Name:CHAN
Middle Name:SUN
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 1:6820 WATER ST NE
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98422-1056
Mailing Address - Country:US
Mailing Address - Phone:253-732-3564
Mailing Address - Fax:877-425-1425
Practice Address - Street 1:9312 S TACOMA WAY STE 115
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-4474
Practice Address - Country:US
Practice Address - Phone:253-251-2551
Practice Address - Fax:253-251-3197
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-12
Last Update Date:2017-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA000358342081N0008X
WAMD000358342081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081N0008XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationNeuromuscular Medicine
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1114321Medicaid
WA0150123OtherSTATE WORKERS' COMP NUMBR
WA0150123OtherSTATE WORKERS' COMP NUMBR
WA1114321Medicaid