Basic Information
Provider Information
NPI: 1265811582
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: DONG
FirstName: STEPHEN
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 201 16TH AVE E
Address2:  
City: SEATTLE
State: WA
PostalCode: 981125226
CountryCode: US
TelephoneNumber: 2063263000
FaxNumber: 2063262785
Practice Location
Address1: 201 16TH AVE E
Address2:  
City: SEATTLE
State: WA
PostalCode: 981125226
CountryCode: US
TelephoneNumber: 2063263000
FaxNumber: 2063262785
Other Information
ProviderEnumerationDate: 05/19/2015
LastUpdateDate: 08/10/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 08/10/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RH0003XMD61138345WAY Allopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology

No ID Information.


Home