Provider Demographics
NPI:1457681918
Name:CUAYCONG, MARY JEAN (MD)
Entity type:Individual
Prefix:DR
First Name:MARY JEAN
Middle Name:
Last Name:CUAYCONG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8609 EVERGREEN WAY
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98208-2619
Mailing Address - Country:US
Mailing Address - Phone:425-789-3745
Mailing Address - Fax:
Practice Address - Street 1:8609 EVERGREEN WAY
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98208-2619
Practice Address - Country:US
Practice Address - Phone:425-789-3745
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-06
Last Update Date:2024-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00048231207W00000X, 207R00000X
IA49540208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist