Healthcare Provider Details

I. General information

NPI: 1083151914
Provider Name (Legal Business Name): ALASKA PLASTIC SURGERY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2017
Last Update Date: 01/30/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 MADISON ST SUITE 1270
SEATTLE WA
98104-1306
US

IV. Provider business mailing address

3100 TONGASS AVE
KETCHIKAN AK
99901-5746
US

V. Phone/Fax

Practice location:
  • Phone: 206-292-6200
  • Fax: 206-708-2226
Mailing address:
  • Phone: 206-292-6200
  • Fax: 206-708-2226

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: CINDY WEI
Title or Position: OWNER
Credential: MD
Phone: 206-292-6200