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General NPI Number Information
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NPI Number | 1780522615
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Entity Type | Organization
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Legal Business Name | WESTERN WASHINGTON MEDICAL GROUP, INC PS
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Dates
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Enumeration Date | 03/23/2026
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Last Update Date | 03/23/2026
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Provider Practice Location Address
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Address Line | 1909 214TH ST SE STE 205
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City | BOTHELL
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State | WA
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Zip | 98021-4415
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Country | US
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Telephone | 425-259-4041
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Fax |
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Provider Business Mailing Address
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Address Line | 1728 W MARINE VIEW DR STE 110
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City | EVERETT
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State | WA
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Zip | 98201-2094
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Country | US
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Telephone | 425-259-4041
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Fax | 425-740-4155
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Authorized Official
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Title or Position | CEO
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Name | DAVID RUSSIAN
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Credential | MD
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Telephone | 425-259-4041
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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 |
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License Number State |
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