Healthcare Provider Details

I. General information

NPI: 1417068677
Provider Name (Legal Business Name): JENNIFER M ZUMSTEG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER M KETTLER M.D.

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 04/26/2022
Certification Date: 04/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 S 43RD ST
RENTON WA
98055-5714
US

IV. Provider business mailing address

400 S 43RD ST
RENTON WA
98055-5714
US

V. Phone/Fax

Practice location:
  • Phone: 425-690-3650
  • Fax: 425-690-9650
Mailing address:
  • Phone: 425-690-3650
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberMD60036809
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: