Healthcare Provider Details

I. General information

NPI: 1861545535
Provider Name (Legal Business Name): JONATHAN A RHIM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 04/29/2021
Certification Date: 04/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 16TH AVE E
SEATTLE WA
98112-5211
US

IV. Provider business mailing address

125 16TH AVE E
SEATTLE WA
98112-5211
US

V. Phone/Fax

Practice location:
  • Phone: 206-326-3000
  • Fax: 206-326-2785
Mailing address:
  • Phone: 206-326-3000
  • Fax: 206-326-2785

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZD0900X
TaxonomyDermatopathology (Pathology) Physician
License NumberMD00035557
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: