Healthcare Provider Details

I. General information

NPI: 1922540004
Provider Name (Legal Business Name): KING COUNTY PUBLIC HOSPITAL DISTRICT NO 2
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2016
Last Update Date: 11/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12710 TOTEM LAKE BLVD NE
KIRKLAND WA
98034-2907
US

IV. Provider business mailing address

10131 MAIN ST
BOTHELL WA
98011-3425
US

V. Phone/Fax

Practice location:
  • Phone: 425-821-4040
  • Fax: 425-820-5060
Mailing address:
  • Phone: 425-485-3955
  • Fax: 425-485-1476

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number StateWA

VIII. Authorized Official

Name: ROBERT MALTE
Title or Position: CEO
Credential:
Phone: 425-899-2610