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General NPI Number Information
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NPI Number | 1992401897
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Entity Type | Organization
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Legal Business Name | DELTA MEDICAL CLINIC LLC
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Dates
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Enumeration Date | 02/01/2023
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Last Update Date | 06/04/2024
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Provider Practice Location Address
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Address Line | 4215 198TH ST SW STE 102
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City | LYNNWOOD
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State | WA
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Zip | 98036-6738
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Country | US
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Telephone | 425-725-9659
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Fax |
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Provider Business Mailing Address
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Address Line | 17806 5TH AVE NE
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City | SHORELINE
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State | WA
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Zip | 98155-3513
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Country | US
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Telephone | 206-794-9948
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Fax |
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Authorized Official
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Title or Position | PRACTITIONER
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Name | UYEN N NGUYEN
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Credential |
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Telephone | 206-794-2015
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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