Healthcare Provider Details

I. General information

NPI: 1245503812
Provider Name (Legal Business Name): AYHAN YAVUZ CL, HP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2012
Last Update Date: 02/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12900 NE 180TH ST
BOTHELL WA
98011-5773
US

IV. Provider business mailing address

12900 NE 180TH ST
BOTHELL WA
98011-5773
US

V. Phone/Fax

Practice location:
  • Phone: 425-802-5010
  • Fax:
Mailing address:
  • Phone: 425-802-5010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberCL60172338
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: