Healthcare Provider Details

I. General information

NPI: 1881754984
Provider Name (Legal Business Name): ANKLE & FOOT CL OF RENTON PS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 10/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 SW 41ST ST
RENTON WA
98057-4930
US

IV. Provider business mailing address

275 SW 41ST ST
RENTON WA
98057-4930
US

V. Phone/Fax

Practice location:
  • Phone: 425-251-9174
  • Fax: 425-251-0758
Mailing address:
  • Phone: 425-251-9174
  • Fax: 425-251-0758

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP1100X
TaxonomyPodiatric Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. GERALD T KUWADA
Title or Position: PRESIDENT
Credential: DPM
Phone: 425-251-9174