104th Avenue Medical Clinic Incorporated
104th Avenue Medical Clinic Incorporated provides Clinic/Center services in Kent, Washington. Licensed in Washington. Registered with an NPI since 2008.
- Licensed in
- WA
- In the registry since
- 2008
Practice location Address checks out
24604 104th Ave SE # 202Kent, WA 98030-5385 Not confirmed with CMS for 12 years — call before visiting
Phone: (253) 859-8371
Fax: (253) 859-9593
Show map & directions
Directions in Google Maps · Apple Maps · OpenStreetMap
Pin is approximate — placed at the ZIP-code centre, not the exact door.
Specialties & licences
| Clinic/Center (primary) | Taxonomy 261Q00000X · Licence 37861 (WA) |
|---|
Record details
| NPI number | 1396921326 |
|---|---|
| Entity type | Organization (Type 2) |
| Organization subpart | No |
| Authorized official | Ranu Choudhary — Vice-President · (253) 859-8371 |
| NPI enumerated | January 22, 2008 |
| Last updated in NPPES | October 1, 2014 |
| Mailing address | 24604 104th Ave Se, 202, Kent, WA 98030-5385 |
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