Provider Demographics
NPI:1376306852
Name:EAR NOSE AND THROAT ASSOCIATES SOUTHWEST INC PS
Entity Type:Organization
Organization Name:EAR NOSE AND THROAT ASSOCIATES SOUTHWEST INC PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SUNG-WON
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:360-357-6314
Mailing Address - Street 1:128 LILLY RD NE STE 202
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98506-7400
Mailing Address - Country:US
Mailing Address - Phone:360-357-6314
Mailing Address - Fax:360-705-3745
Practice Address - Street 1:128 LILLY RD NE STE 202
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506-7400
Practice Address - Country:US
Practice Address - Phone:360-357-6314
Practice Address - Fax:360-705-3745
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EAR NOSE AND THROAT ASSOCIATES SOUTHWEST INC PS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-02-06
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty