Healthcare Provider Details

I. General information

NPI: 1477644938
Provider Name (Legal Business Name): KENT S. DAVIS M.D., F.A.C.O.G.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 12/09/2022
Certification Date: 12/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17722 TALBOT RD S
RENTON WA
98055-5744
US

IV. Provider business mailing address

17722 TALBOT RD S
RENTON WA
98055-5744
US

V. Phone/Fax

Practice location:
  • Phone: 425-690-3479
  • Fax: 425-690-9479
Mailing address:
  • Phone: 425-690-3479
  • Fax: 425-690-9479

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD00041829
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: