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General NPI Number Information
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NPI Number | 1215928668
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Entity Type | Organization
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Legal Business Name | NW ALLERGY & ASTHMA SPECIALISTS,LLC
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Dates
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Enumeration Date | 11/03/2005
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Last Update Date | 11/26/2024
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Provider Practice Location Address
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Address Line | 4915 SW GRIFFITH DR STE 304
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City | BEAVERTON
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State | OR
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Zip | 97005-2933
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Country | US
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Telephone | 503-620-5614
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Fax | 503-598-4688
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Provider Business Mailing Address
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Address Line | 43575 MISSION BLVD STE 716
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City | FREMONT
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State | CA
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Zip | 94539-5831
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Country | US
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Telephone | 408-476-0624
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Fax |
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Authorized Official
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Title or Position | COO
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Name | RAJEEV JAIN
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Credential |
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Telephone | 408-476-0624
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207K00000X
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Taxonomy Name | Allergy & Immunology Physician
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License Number |
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License Number State |
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