Healthcare Provider Details

I. General information

NPI: 1902167471
Provider Name (Legal Business Name): ANKLE & FOOT SPECIALISTS OF PUGET SOUND, PS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2012
Last Update Date: 05/31/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18100 NE UNION HILL RD SUITE 200
REDMOND WA
98052-3330
US

IV. Provider business mailing address

2728 E MAIN SUITE A
PUYALLUP WA
98372-3198
US

V. Phone/Fax

Practice location:
  • Phone: 425-644-2313
  • Fax: 425-644-4739
Mailing address:
  • Phone: 425-644-2313
  • Fax: 425-644-4739

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberPO00000277
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPO00000277
License Number StateWA

VIII. Authorized Official

Name: CHARLES R CHU
Title or Position: PHYSICIAN/OWNER
Credential: DPM
Phone: 425-449-2471