Healthcare Provider Details

I. General information

NPI: 1942593165
Provider Name (Legal Business Name): VINCENT N MUONEKE MD PS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2011
Last Update Date: 09/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16233 SYLVESTER RD SW SUITE 280
BURIEN WA
98166-3045
US

IV. Provider business mailing address

16233 SYLVESTER RD SW SUITE 280
BURIEN WA
98166-3045
US

V. Phone/Fax

Practice location:
  • Phone: 206-248-6992
  • Fax: 206-248-7363
Mailing address:
  • Phone: 206-248-6992
  • Fax: 206-248-7363

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberMD00027931
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License NumberMD00027931
License Number StateWA

VIII. Authorized Official

Name: DR. VINCENT N MUONEKE
Title or Position: OWNER
Credential: M.D., P.S.
Phone: 206-248-6992