Healthcare Provider Details

I. General information

NPI: 1164720462
Provider Name (Legal Business Name): ANKLE & FOOT SPECIALISTS OF PUGET SOUND, PS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2011
Last Update Date: 07/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2820 GRIFFIN AVE SUITE 101
ENUMCLAW WA
98022-2373
US

IV. Provider business mailing address

2728 E MAIN AVE SUITE A
PUYALLUP WA
98372-3198
US

V. Phone/Fax

Practice location:
  • Phone: 360-825-2181
  • Fax: 360-825-8354
Mailing address:
  • Phone: 253-841-2006
  • Fax: 253-840-6691

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State

VIII. Authorized Official

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