Healthcare Provider Details

I. General information

NPI: 1629016365
Provider Name (Legal Business Name): SANJAY K PERTI CPO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2006
Last Update Date: 02/13/2025
Certification Date: 02/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11417 124TH AVE NE STE 103
KIRKLAND WA
98033-4677
US

IV. Provider business mailing address

7047 17TH AVE NW
SEATTLE WA
98117-5551
US

V. Phone/Fax

Practice location:
  • Phone: 425-576-5050
  • Fax: 206-202-0866
Mailing address:
  • Phone: 425-576-5050
  • Fax: 206-202-0866

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code222Z00000X
TaxonomyOrthotist
License NumberOI00000421
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code224P00000X
TaxonomyProsthetist
License NumberPS00000440
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: