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General NPI Number Information
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NPI Number | 1154764413
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Entity Type | Organization
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Legal Business Name | WHOLE FAMILY CLINIC, LLC
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Dates
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Enumeration Date | 04/16/2013
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Last Update Date | 04/16/2013
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Provider Practice Location Address
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Address Line | 1530 140TH AVE NE SUITE 101
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City | BELLEVUE
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State | WA
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Zip | 98005-4574
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Country | US
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Telephone | 206-295-3855
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Fax |
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Provider Business Mailing Address
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Address Line | 2980 N BEVERLY GLEN CIR SUITE 301
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City | LOS ANGELES
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State | CA
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Zip | 90077-1726
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Country | US
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Telephone | 310-474-9809
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. DINA M. KISSELEVA
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Credential | ND
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Telephone | 206-295-3855
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332900000X
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Taxonomy Name | Non-Pharmacy Dispensing Site
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License Number |
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License Number State |
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