Healthcare Provider Details

I. General information

NPI: 1427109271
Provider Name (Legal Business Name): LAKE WASHINGTON PRIVATE MEDICINE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 01/01/2024
Certification Date: 01/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13122 120TH AVE NE
KIRKLAND WA
98034-3014
US

IV. Provider business mailing address

13122 120TH AVE NE
KIRKLAND WA
98034-3014
US

V. Phone/Fax

Practice location:
  • Phone: 425-678-8534
  • Fax: 425-678-8564
Mailing address:
  • Phone: 425-678-8534
  • Fax: 425-678-8564

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number602289671
License Number StateWA

VIII. Authorized Official

Name: DR. DAVID KEITH NAIBERT
Title or Position: OWNER
Credential: MD
Phone: 425-678-8534