Basic Information
Provider Information
NPI: 1306379623
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HUANG
FirstName: KATHERINE
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: DO
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 5127
Address2:  
City: EVERETT
State: WA
PostalCode: 982065127
CountryCode: US
TelephoneNumber: 4253048431
FaxNumber:  
Practice Location
Address1: 1321 COLBY AVE
Address2:  
City: EVERETT
State: WA
PostalCode: 982011665
CountryCode: US
TelephoneNumber: 4252612000
FaxNumber:  
Other Information
ProviderEnumerationDate: 04/04/2017
LastUpdateDate: 09/16/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 09/16/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207R00000X20A18083CAN Allopathic & Osteopathic PhysiciansInternal Medicine 
208M00000X20A18083CAN Allopathic & Osteopathic PhysiciansHospitalist 
207R00000XOP61249950WAY Allopathic & Osteopathic PhysiciansInternal Medicine 

No ID Information.


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