Provider Demographics
NPI:1013133636
Name:KEN C HWAHN, OD PS
Entity Type:Organization
Organization Name:KEN C HWAHN, OD PS
Other - Org Name:WESTLAKE EYE CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:KEN
Authorized Official - Middle Name:HWAHN
Authorized Official - Last Name:C
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:206-624-4898
Mailing Address - Street 1:400 PINE ST STE 30
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98101-3648
Mailing Address - Country:US
Mailing Address - Phone:206-624-4898
Mailing Address - Fax:
Practice Address - Street 1:400 PINE ST STE 30
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-3648
Practice Address - Country:US
Practice Address - Phone:206-624-4898
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAWA1720152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAWA1720OtherSTATE LICENSE #
WAWA1720OtherSTATE LICENSE #
WA11500288Medicare ID - Type Unspecified
WAT02923Medicare UPIN