104th Avenue Medical Clinic Incorporated

NPI 1396921326 - Clinic/Center - 261Q00000X

NPI Details
NPI 1396921326
Enumeration Date 01/22/2008
Last Updated 10/01/2014
Entity Type Healthcare Provider
Active Over 8 years ago
Authorized Information
Name RANU RANU
Position VICE-PRESIDENT
Phone (253) 859-8371
Fax (253) 859-9593
Practice Location
24604 104TH AVE SE
# 202
KENT WA, 98030-5385, US
Phone (253) 859-8371
Fax (253) 859-9593
Business Location
24604 104TH AVE SE
# 202
KENT WA, 98030-5385, US
Phone (253) 859-8371
Fax
Toxanomy
Taxonomy Code 261Q00000X
License State Washington
License Number 37861
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According to our database, 104th Avenue Medical Clinic Incorporated NPI is 1396921326, taxonomy code is 261Q00000X and license number is 37861, license state is located at Washington. 104th Avenue Medical Clinic Incorporated physically located at 24604 104th Ave Se, Kent WA, 98030-5385. NPI Number 1033115704 has the healthcare provider type.

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1396921326 NPI number is provided on an as is basis without warranty of any kind. 1396921326 is maintained by the National Plan & Provider Enumeration System. The contents of 104th Avenue Medical Clinic Incorporated are for informational purposes only.