Provider Demographics
NPI:1043840200
Name:KJELD AAMODT PC
Entity Type:Organization
Organization Name:KJELD AAMODT PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KJELD
Authorized Official - Middle Name:
Authorized Official - Last Name:AAMODT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:831-238-7285
Mailing Address - Street 1:999 SUTTER ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94109-6023
Mailing Address - Country:US
Mailing Address - Phone:415-653-3087
Mailing Address - Fax:
Practice Address - Street 1:500 108TH AVE NE STE 1710
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-5598
Practice Address - Country:US
Practice Address - Phone:415-653-3087
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-16
Last Update Date:2020-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty