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General NPI Number Information
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NPI Number | 1134162308
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Entity Type | Organization
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Legal Business Name | K-Y SURGICAL ASSOC
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Dates
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Enumeration Date | 06/14/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1307 S 11TH ST
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City | TACOMA
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State | WA
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Zip | 98405-3644
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Country | US
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Telephone | 253-274-9732
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Fax | 253-274-9736
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Provider Business Mailing Address
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Address Line | 5121 CROMWELL DR NW
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City | GIG HARBOR
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State | WA
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Zip | 98335-7545
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Country | US
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Telephone | 253-274-9732
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Fax | 253-274-9736
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | LOU JOUBERT
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Credential |
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Telephone | 253-274-9732
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State |
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