Healthcare Provider Details

I. General information

NPI: 1225202674
Provider Name (Legal Business Name): MEDICAL IMAGING NORTHWEST
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2008
Last Update Date: 12/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17700 SE 272ND ST
COVINGTON WA
98042-4951
US

IV. Provider business mailing address

1201 PACIFIC AVE SUITE 400
TACOMA WA
98402-4301
US

V. Phone/Fax

Practice location:
  • Phone: 253-372-7040
  • Fax: 253-372-7042
Mailing address:
  • Phone: 253-841-4353
  • Fax: 253-583-8630

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. KATHERINE CHOI-CHINN
Title or Position: CHAIR EXECUTIVE COMMITTEE
Credential: MD
Phone: 253-841-4353