| |
1912 201st Pl Se Suite 204 Bothell WA 98012-8570 | |
(425) 485-6812 | |
(425) 485-6813 |
Full Name | |
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Speciality | Clinic/center |
Location | 1912 201st Pl Se, Bothell, Washington |
Authorized Official Name and Position | Jaclyn T Phan (PRESIDENT) |
Authorized Official Contact | 4254856812 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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1912 201st Pl Se Suite 204 Bothell WA 98012-8570 Ph: (425) 485-6812 | 1912 201st Pl Se Suite 204 Bothell WA 98012-8570 Ph: (425) 485-6812 |
NPI Number | 1437330123 |
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Provider Enumeration Date | 11/21/2007 |
Last Update Date | 11/21/2007 |
Identifier | Type | State | Issuer |
---|---|---|---|
1437330123 | NPI | - | NPPES |
2033652 | Medicaid | WA |
Taxonomy | Type | License (State) | Status |
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261Q00000X | Clinic/center | 3357 (Washington) | Primary |
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