Healthcare Provider Details

I. General information

NPI: 1013313949
Provider Name (Legal Business Name): ANKLE & FOOT SPECIALISTS OF PUGET SOUND, PS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2014
Last Update Date: 12/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17700 SE 272ND ST STE 370
COVINGTON WA
98042-4951
US

IV. Provider business mailing address

17700 SE 272ND ST STE 370
COVINGTON WA
98042-4951
US

V. Phone/Fax

Practice location:
  • Phone: 253-631-0585
  • Fax:
Mailing address:
  • Phone: 253-631-0585
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number StateWA

VIII. Authorized Official

Name: CHARLES R CHU
Title or Position: PODIATRIST/OWNER
Credential: DPM
Phone: 425-449-2471