Provider Demographics
NPI:1346495322
Name:KATHRYN PONTO MD PLLC
Entity Type:Organization
Organization Name:KATHRYN PONTO MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:
Authorized Official - Last Name:PONTO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:425-821-2020
Mailing Address - Street 1:13030 121ST WAY NE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-3008
Mailing Address - Country:US
Mailing Address - Phone:425-821-2020
Mailing Address - Fax:425-823-8273
Practice Address - Street 1:13030 121ST WAY NE
Practice Address - Street 2:SUITE 202
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-3008
Practice Address - Country:US
Practice Address - Phone:425-821-2020
Practice Address - Fax:425-823-8273
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-18
Last Update Date:2008-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00025961174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty