Healthcare Provider Details

I. General information

NPI: 1568332708
Provider Name (Legal Business Name): SAMUEL NJUGUNA NJOKI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/11/2025
Last Update Date: 11/11/2025
Certification Date: 11/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3431 MAIN AVE S
RENTON WA
98055-5770
US

IV. Provider business mailing address

3431 MAIN AVE S
RENTON WA
98055-5770
US

V. Phone/Fax

Practice location:
  • Phone: 206-859-3372
  • Fax:
Mailing address:
  • Phone: 206-859-3372
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberNC.61384004
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: