Healthcare Provider Details

I. General information

NPI: 1043840200
Provider Name (Legal Business Name): KJELD AAMODT PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2020
Last Update Date: 04/17/2020
Certification Date: 04/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 108TH AVE NE STE 1710
BELLEVUE WA
98004-5598
US

IV. Provider business mailing address

999 SUTTER ST
SAN FRANCISCO CA
94109-6023
US

V. Phone/Fax

Practice location:
  • Phone: 415-653-3087
  • Fax:
Mailing address:
  • Phone: 415-653-3087
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: KJELD AAMODT
Title or Position: OWNER
Credential:
Phone: 831-238-7285