Healthcare Provider Details

I. General information

NPI: 1558435040
Provider Name (Legal Business Name): IPP, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1629 220TH ST SE SUITE 204
BOTHELL WA
98021-8466
US

IV. Provider business mailing address

PO BOX 490
BOTHELL WA
98041-0490
US

V. Phone/Fax

Practice location:
  • Phone: 425-939-5157
  • Fax: 425-939-5202
Mailing address:
  • Phone: 425-939-5157
  • Fax: 425-939-5202

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number StateWA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier8410IN
Identifier TypeOTHER
Identifier StateWA
Identifier IssuerREGENCE
# 2
Identifier0156259
Identifier TypeOTHER
Identifier StateWA
Identifier IssuerLABOR & INDUSTRIES

VIII. Authorized Official

Name: SOLOMON KAMSON
Title or Position: PRESIDENT
Credential: M.D.
Phone: 425-486-1000