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General NPI Number Information
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NPI Number | 1407179690
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Entity Type | Individual
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Provider Name | CHRISTOPHER JOEL SHAW PA-C
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Gender | Male
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Dates
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Enumeration Date | 03/02/2010
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Last Update Date | 02/09/2015
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Provider Practice Location Address
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Address Line | 11800 NE 128TH ST SUITE 300
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City | KIRKLAND
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State | WA
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Zip | 98034-7208
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Country | US
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Telephone | 425-814-5100
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Fax | 425-814-5103
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Provider Business Mailing Address
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Address Line | 13236 NE 129TH PL
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City | KIRKLAND
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State | WA
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Zip | 98034-3361
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Country | US
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Telephone | 425-814-5100
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Fax | 425-814-5103
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA60124508
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License Number State | WA
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