Provider Demographics
NPI:1457578601
Name:HAO, ZALES O (PA)
Entity Type:Individual
Prefix:MR
First Name:ZALES
Middle Name:O
Last Name:HAO
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12459 AMBAUM BLVD SW
Mailing Address - Street 2:SUITE A
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98146-2696
Mailing Address - Country:US
Mailing Address - Phone:206-444-6533
Mailing Address - Fax:206-439-0426
Practice Address - Street 1:12459 AMBAUM BLVD SW
Practice Address - Street 2:SUITE A
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98146-2696
Practice Address - Country:US
Practice Address - Phone:206-444-6533
Practice Address - Fax:206-439-0426
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10001671363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA127675OtherL AND I
WA8314189Medicaid
WAHA6427OtherREGENCE
WA8314189Medicaid
WA127675OtherL AND I