Provider Demographics
NPI:1376174979
Name:EDMONDS MEDICAL CLINIC INC
Entity Type:Organization
Organization Name:EDMONDS MEDICAL CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:KOH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-582-7753
Mailing Address - Street 1:21600 HIGHWAY 99 STE 280
Mailing Address - Street 2:
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98026-8022
Mailing Address - Country:US
Mailing Address - Phone:425-582-7753
Mailing Address - Fax:425-740-0078
Practice Address - Street 1:21600 HIGHWAY 99 STE 280
Practice Address - Street 2:
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026-8022
Practice Address - Country:US
Practice Address - Phone:360-901-6355
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-01
Last Update Date:2020-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty