Provider Demographics
NPI:1225303423
Name:NORTHWEST PROFESSIONAL MEDICINE
Entity Type:Organization
Organization Name:NORTHWEST PROFESSIONAL MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ELDI
Authorized Official - Middle Name:
Authorized Official - Last Name:HAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:206-257-2237
Mailing Address - Street 1:93 S JACKSON ST
Mailing Address - Street 2:21499
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98104-2818
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:93 S JACKSON ST
Practice Address - Street 2:21499
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-2818
Practice Address - Country:US
Practice Address - Phone:206-257-2237
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-20
Last Update Date:2012-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00044383174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty