104th Avenue Medical Clinic Incorporated

NPI #1396921326 in Kent, Washington

Provider Information

NPI Number: 1396921326
Entity Type: Organization
Organization Name: 104th Avenue Medical Clinic Incorporated
Primary Specialty: Clinic/Center
Enumeration Date: Jan 22, 2008
Last Updated: Oct 1, 2014

Practice Location

Address: 24604 104TH AVE SE
Address 2: # 202
City: Kent
State: Washington
ZIP Code: 98030-5385
Phone: (253) 859-8371

Authorized Official

Name: RANU CHOUDHARY, M.D.
Title: VICE-PRESIDENT
Phone: (253) 859-8371

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Clinic/Center	261Q00000X	Primary

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