Healthcare Provider Details

I. General information

NPI: 1841379369
Provider Name (Legal Business Name): SEATTLE EAR NOSE THROAT TR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2006
Last Update Date: 11/06/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10330 MERIDIAN AVE N SUITE 190
SEATTLE WA
98133-9451
US

IV. Provider business mailing address

PO BOX 3129
LYNNWOOD WA
98046-3129
US

V. Phone/Fax

Practice location:
  • Phone: 206-389-7100
  • Fax: 206-389-7101
Mailing address:
  • Phone: 425-712-3417
  • Fax: 425-712-3710

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberMD00045832
License Number StateWA

VIII. Authorized Official

Name: KAREN LIN
Title or Position: PHYSICIAN
Credential: MD
Phone: 206-389-7100