Provider Demographics
NPI:1669430948
Name:LAKIN, HUONG T (DO)
Entity type:Individual
Prefix:
First Name:HUONG
Middle Name:T
Last Name:LAKIN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:HUONG
Other - Middle Name:T
Other - Last Name:WOOTEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:669 WOODLAND SQUARE LOOP SE
Mailing Address - Street 2:
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98503-1038
Mailing Address - Country:US
Mailing Address - Phone:360-359-4840
Mailing Address - Fax:360-359-4850
Practice Address - Street 1:669 WOODLAND SQUARE LOOP SE
Practice Address - Street 2:
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98503-1038
Practice Address - Country:US
Practice Address - Phone:360-359-4840
Practice Address - Fax:360-359-4850
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-03
Last Update Date:2014-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP00001767207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8298416Medicaid
WAGAB28880Medicare ID - Type Unspecified
WAH36407Medicare UPIN