104TH AVENUE MEDICAL CLINIC INCORPORATED is a clinic center in Kent, WA. The provider is a facility or distinct part of one used for the diagnosis and treatment of outpatients. Clinic/Center is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health). 104TH AVENUE MEDICAL CLINIC INCORPORATED NPI is 1396921326. The provider is registered as an organization entity type.
The provider's business location address is:
24604 104TH AVE SE
# 202
KENT, WA
ZIP 98030-385
Phone: (253) 859-8371
Fax: (253) 859-9593
The provider's authorized official is Ranu Choudhary .
The authorized official title is Vice-president and has the following contact phone number (253) 859-8371.
The CLIA number assigned to this NPI record is 50D0976109 - other with a certificate type of Certificate of Waiver.
The enumeration date for this NPI number is 1/22/2008 and was last updated on 10/1/2014.