Basic Information
Provider Information
NPI: 1811256449
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: WOO
FirstName: STEPHEN
MiddleName: CHIHOON
NamePrefix:  
NameSuffix:  
Credential: D.O.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 850
Address2:  
City: PORT ANGELES
State: WA
PostalCode: 983620146
CountryCode: US
TelephoneNumber: 3605650999
FaxNumber: 3605824221
Practice Location
Address1: 800 N 5TH AVE STE 101
Address2:  
City: SEQUIM
State: WA
PostalCode: 983823045
CountryCode: US
TelephoneNumber: 3605650999
FaxNumber: 3605824221
Other Information
ProviderEnumerationDate: 05/16/2012
LastUpdateDate: 05/23/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 05/23/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207Q00000XOP60527165WAY Allopathic & Osteopathic PhysiciansFamily Medicine 

No ID Information.


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