Provider Demographics
NPI:1316079254
Name:JOHN HUNG, MD, PLLC
Entity type:Organization
Organization Name:JOHN HUNG, MD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIE
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:NASH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-446-0750
Mailing Address - Street 1:11212 SUNRISE BLVD E
Mailing Address - Street 2:SUITE 201
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98374-8847
Mailing Address - Country:US
Mailing Address - Phone:253-446-0750
Mailing Address - Fax:253-446-0757
Practice Address - Street 1:11212 SUNRISE BLVD E
Practice Address - Street 2:SUITE 201
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98374-8847
Practice Address - Country:US
Practice Address - Phone:253-446-0750
Practice Address - Fax:253-446-0757
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-09
Last Update Date:2008-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00046263207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1123140Medicaid
WA1684HUOtherREGENCE
WA1123140Medicaid