Healthcare Provider Details

I. General information

NPI: 1457796112
Provider Name (Legal Business Name): TENSEGRITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2013
Last Update Date: 05/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 108TH AVE NE STE 1
BELLEVUE WA
98004-5578
US

IV. Provider business mailing address

555 108TH AVE NE STE 1
BELLEVUE WA
98004-5578
US

V. Phone/Fax

Practice location:
  • Phone: 425-452-9280
  • Fax: 425-452-9306
Mailing address:
  • Phone: 425-452-9280
  • Fax: 425-452-9306

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305S00000X
TaxonomyPoint of Service
License NumberMA60147179
License Number StateWA

VIII. Authorized Official

Name: MR. KHO-HAY ENOS
Title or Position: OWNER
Credential: L.M.P.
Phone: 253-226-7021