Provider Demographics
NPI:1912154022
Name:HULST, JONAH B (MD)
Entity type:Individual
Prefix:
First Name:JONAH
Middle Name:B
Last Name:HULST
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 8TH AVE NE STE 320
Mailing Address - Street 2:
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98029-5436
Mailing Address - Country:US
Mailing Address - Phone:425-507-0733
Mailing Address - Fax:425-283-5551
Practice Address - Street 1:3101 NORTHUP WAY
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-1449
Practice Address - Country:US
Practice Address - Phone:425-455-3600
Practice Address - Fax:425-455-3920
Is Sole Proprietor?:No
Enumeration Date:2008-08-20
Last Update Date:2024-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60290797207XS0114X, 207X00000X
IL036-128314207XS0114X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2115214Medicaid
WA327227OtherLABOR & INDUSTRIES