Healthcare Provider Details

I. General information

NPI: 1134084478
Provider Name (Legal Business Name): MARTIAL NJUH MBABID
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/18/2025
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 W JAMES LN APT 2K07
KENT WA
98032-4354
US

IV. Provider business mailing address

1601 W JAMES LN APT 2K07
KENT WA
98032-4354
US

V. Phone/Fax

Practice location:
  • Phone: 346-322-6660
  • Fax:
Mailing address:
  • Phone: 346-322-6660
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: