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General NPI Number Information
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NPI Number | 1407800956
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Entity Type | Organization
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Legal Business Name | KENT FAMILY MEDICAL CLINIC LLC
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Dates
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Enumeration Date | 05/20/2006
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Last Update Date | 11/06/2007
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Provider Practice Location Address
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Address Line | 10830 SE KENT KANGLEY RD 100A
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City | KENT
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State | WA
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Zip | 98030-9959
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Country | US
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Telephone | 253-520-7390
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Fax | 253-520-7028
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Provider Business Mailing Address
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Address Line | 12932 SE KENT KANGLEY RD 184
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City | KENT
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State | WA
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Zip | 98030-7940
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Country | US
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Telephone | 253-520-7390
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Fax | 253-520-7028
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Authorized Official
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Title or Position | MEMBER/MANAGER
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Name | DR. HARPREET SINGH CHHOKAR
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Credential | M.D.
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Telephone | 253-520-7390
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MD00045566
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License Number State | WA
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