Healthcare Provider Details

I. General information

NPI: 1023061553
Provider Name (Legal Business Name): EVERGREEN CARDIOLOGY CARE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8301 161ST AVE NE SUITE 302
REDMOND WA
98052-3858
US

IV. Provider business mailing address

PO BOX 13684
SEATTLE WA
98198-1010
US

V. Phone/Fax

Practice location:
  • Phone: 800-243-5854
  • Fax: 206-824-9510
Mailing address:
  • Phone: 800-243-5854
  • Fax: 206-824-9510

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: DR. DENNIS M ENOMOTO
Title or Position: PRESIDENT/OWNER
Credential: MD
Phone: 425-882-4700