Provider Demographics
NPI:1891226700
Name:KEN C HWAHN, O.D. P.S.
Entity Type:Organization
Organization Name:KEN C HWAHN, O.D. P.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:KARI
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-431-8770
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-22
Last Update Date:2017-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00001720152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty