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General NPI Number Information
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NPI Number | 1538577952
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Entity Type | Organization
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Legal Business Name | WASHINGTON PODIATRY
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Dates
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Enumeration Date | 07/29/2014
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Last Update Date | 07/29/2014
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Provider Practice Location Address
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Address Line | 22510 SE 64TH PL
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City | ISSAQUAH
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State | WA
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Zip | 98027-5390
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Country | US
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Telephone | 800-554-8144
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Fax |
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Provider Business Mailing Address
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Address Line | 7140 115TH CT SE
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City | NEWCASTLE
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State | WA
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Zip | 98056-1029
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. STEPHANIE KIM
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Credential | DPM
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Telephone | 206-321-2722
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | PO60204241
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License Number State | WA
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