Healthcare Provider Details

I. General information

NPI: 1447390430
Provider Name (Legal Business Name): THE KIDS CLINIC, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 07/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

319 W 8TH AVE
SPOKANE WA
99204-2505
US

IV. Provider business mailing address

319 W 8TH AVE
SPOKANE WA
99204-2505
US

V. Phone/Fax

Practice location:
  • Phone: 509-448-7337
  • Fax: 509-448-4750
Mailing address:
  • Phone: 509-448-7337
  • Fax: 509-448-4750

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD00040187
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: JONATHAN J LEE
Title or Position: PARTNER
Credential: MD
Phone: 509-448-7337