Healthcare Provider Details

I. General information

NPI: 1578507919
Provider Name (Legal Business Name): NORTHWEST KIDNEY CENTERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2006
Last Update Date: 10/14/2025
Certification Date: 10/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12901 20TH AVE S
SEATAC WA
98168-5159
US

IV. Provider business mailing address

12901 20TH AVE S STE 100
SEATAC WA
98168-5159
US

V. Phone/Fax

Practice location:
  • Phone: 206-343-4870
  • Fax: 206-343-4884
Mailing address:
  • Phone: 206-292-2771
  • Fax: 206-860-5821

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberCF00003625
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number20609MS
License Number StateID

VIII. Authorized Official

Name: JENNIFER D. ESLAVA
Title or Position: CFO
Credential:
Phone: 206-720-8506