104Th Avenue Medical Clinic Incorporated

LBN: 104Th Avenue Medical Clinic Incorporated
104Th Avenue Medical Clinic Incorporated is an health care organization with primary practice located at 24604 104Th Ave Se # 202, Kent WA 98030-5385. The organization recently has only one registered license in Ambulatory Health Care Facilities / Clinic/Center, which is considered as the primary health care specialty. 104Th Avenue Medical Clinic Incorporated can be contacted via phone (253) 859-8371, or through Choudhary, Ranu via phone (253) 859-8371.

Contact Information

Primary practice address
24604 104Th Ave Se # 202 Kent WA 98030-5385
Phone: (253) 859-8371
Fax: (253) 859-9593
Website:
Map and Directions
Authorized official contact:
Name: Choudhary, Ranu Doctor of Medicine (MD)
Phone: (253) 859-8371

Health care specialties

SpecialtyCodeLicense #State
Ambulatory Health Care Facilities / Clinic/Center 261Q00000X 37861 Washington

Profile Details

NPI number 1396921326
LBN Legal business name 104Th Avenue Medical Clinic Incorporated
DBA Doing business as
Authorized official Choudhary, Ranu Doctor of Medicine (MD)
Entity Organization
Organization subpart 1 No
Enumeration date Jan 22nd, 2008
Last updated Oct 1st, 2014 - about 10 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1396921326 NPPES
Washington MEDICAID 1110378

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