Healthcare Provider Details

I. General information

NPI: 1275989881
Provider Name (Legal Business Name): JOSH HUHNDORF MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2016
Last Update Date: 07/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3915 TALBOT RD S SUITE 401
RENTON WA
98055-5738
US

IV. Provider business mailing address

3915 TALBOT RD S SUITE 401
RENTON WA
98055-5738
US

V. Phone/Fax

Practice location:
  • Phone: 425-228-3440
  • Fax: 425-656-5395
Mailing address:
  • Phone: 425-228-3440
  • Fax: 425-656-5395

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberML60667481
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: