Healthcare Provider Details

I. General information

NPI: 1659582385
Provider Name (Legal Business Name): SOUTHWEST PEDIATRICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14212 AMBAUM BLVD SW SOUTHWEST PEDIATRICS #202
SEATTLE WA
98166-1437
US

IV. Provider business mailing address

14212 AMBAUM BLVD SW #202
SEATTLE WA
98166-1437
US

V. Phone/Fax

Practice location:
  • Phone: 206-243-4811
  • Fax: 206-243-2822
Mailing address:
  • Phone: 206-243-4811
  • Fax: 206-243-2822

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. KENNETH H DONG
Title or Position: VICE PRESIDENT
Credential: MD
Phone: 206-243-4811