Healthcare Provider Details

I. General information

NPI: 1699917369
Provider Name (Legal Business Name): SOUTH SOUND INPATIENT PHYSICIANS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2009
Last Update Date: 11/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2717 DEXTER AVE QUEEN ANNE HEALTHCARE
SEATTLE WA
98109-1914
US

IV. Provider business mailing address

PO BOX 60000 FILE 31045
SAN FRANCISCO CA
94160-0001
US

V. Phone/Fax

Practice location:
  • Phone: 206-284-7012
  • Fax:
Mailing address:
  • Phone: 253-682-1710
  • Fax: 253-284-1881

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. JAMES KODJABABIAN
Title or Position: COO
Credential: COO
Phone: 253-682-6020