Healthcare Provider Details

I. General information

NPI: 1073830618
Provider Name (Legal Business Name): REDMOND FAMILY CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2010
Last Update Date: 11/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8195 166TH AVE NE SUITE 203
REDMOND WA
98052-3960
US

IV. Provider business mailing address

8195 166TH AVE NE SUITE 203
REDMOND WA
98052-3960
US

V. Phone/Fax

Practice location:
  • Phone: 425-310-6519
  • Fax: 425-968-9839
Mailing address:
  • Phone: 425-310-6519
  • Fax: 425-968-9839

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License NumberMD00045554
License Number StateWA

VIII. Authorized Official

Name: PEN HOU
Title or Position: PRINCIPAL
Credential: MD
Phone: 425-310-6519