Healthcare Provider Details

I. General information

NPI: 1023606811
Provider Name (Legal Business Name): ARIUNTULGA TSERENDAVAA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/06/2021
Last Update Date: 01/06/2021
Certification Date: 01/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2098 155TH PL NE APT 102
BELLEVUE WA
98007-5068
US

IV. Provider business mailing address

2098 155TH PL NE APT 102
BELLEVUE WA
98007-5068
US

V. Phone/Fax

Practice location:
  • Phone: 425-652-2029
  • Fax:
Mailing address:
  • Phone: 425-652-2029
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171R00000X
TaxonomyInterpreter
License NumberMA1968
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: