Healthcare Provider Details

I. General information

NPI: 1356404990
Provider Name (Legal Business Name): CHRISTOPHER JACK BERLIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2006
Last Update Date: 05/19/2021
Certification Date: 05/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2715 NACHES AVE SW
RENTON WA
98057-2627
US

IV. Provider business mailing address

2715 NACHES AVE SW
RENTON WA
98057-2627
US

V. Phone/Fax

Practice location:
  • Phone: 206-630-1330
  • Fax:
Mailing address:
  • Phone: 206-630-1330
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD432456
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD60133766
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: