Provider Demographics
NPI:1407800956
Name:KENT FAMILY MEDICAL CLINIC LLC
Entity Type:Organization
Organization Name:KENT FAMILY MEDICAL CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER/MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:HARPREET
Authorized Official - Middle Name:SINGH
Authorized Official - Last Name:CHHOKAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:253-520-7390
Mailing Address - Street 1:12932 SE KENT KANGLEY RD
Mailing Address - Street 2:184
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98030-7940
Mailing Address - Country:US
Mailing Address - Phone:253-520-7390
Mailing Address - Fax:253-520-7028
Practice Address - Street 1:10830 SE KENT KANGLEY RD
Practice Address - Street 2:100A
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98030-9959
Practice Address - Country:US
Practice Address - Phone:253-520-7390
Practice Address - Fax:253-520-7028
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-20
Last Update Date:2007-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00045566207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7132822Medicaid
WA7132822Medicaid