Healthcare Provider Details

I. General information

NPI: 1619218567
Provider Name (Legal Business Name): CARDEN KENDRICK GAMBEE D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2013
Last Update Date: 12/03/2020
Certification Date: 12/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1344 WINTERGREEN LN NE UNIT 100
BAINBRIDGE ISLAND WA
98110-5147
US

IV. Provider business mailing address

1344 WINTERGREEN LN NE UNIT 100
BAINBRIDGE ISLAND WA
98110-5147
US

V. Phone/Fax

Practice location:
  • Phone: 206-201-0488
  • Fax: 206-835-7439
Mailing address:
  • Phone: 206-201-0488
  • Fax: 206-835-7439

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0116025462
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOP60747016
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: