Longevity Medical Clinic

NPI 1023231172 - Specialist - 174400000X

NPI Details
NPI 1023231172
Enumeration Date 04/10/2007
Last Updated 06/21/2011
Entity Type Healthcare Provider
Active Over 9 years ago
Authorized Information
Name JERRY N JERRY
Position MEDICAL DIRECTOR
Phone (425) 576-9272
Fax (425) 576-0894
Practice Location
9757 NE JUANITA DR
SUITE 200
KIRKLAND WA, 98034-4299, US
Phone (425) 576-9272
Fax (425) 576-0894
Business Location
9757 NE JUANITA DR
SUITE 200
KIRKLAND WA, 98034-4299, US
Phone (425) 576-9272
Fax (425) 576-0894
Toxanomy
Taxonomy Code 174400000X
License State Washington
License Number MD23643
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According to our database, Longevity Medical Clinic NPI is 1023231172, taxonomy code is 174400000X and license number is MD23643, license state is located at Washington. Longevity Medical Clinic physically located at 9757 Ne Juanita Dr, Kirkland WA, 98034-4299. NPI Number 1033115704 has the healthcare provider type.

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1023231172 NPI number is provided on an as is basis without warranty of any kind. 1023231172 is maintained by the National Plan & Provider Enumeration System. The contents of Longevity Medical Clinic are for informational purposes only.