Healthcare Provider Details

I. General information

NPI: 1215922638
Provider Name (Legal Business Name): SUZINNE PAK GORSTEIN MD PHD MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/12/2005
Last Update Date: 12/11/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 9TH AVE BOX 359774
SEATTLE WA
98104-2420
US

IV. Provider business mailing address

6016 1ST AVE NW
SEATTLE WA
98107-2007
US

V. Phone/Fax

Practice location:
  • Phone: 206-744-9512
  • Fax: 206-744-9862
Mailing address:
  • Phone: 206-679-2460
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License NumberMD00045046
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: