Provider Demographics
NPI:1467505172
Name:MOUNT RAINIER NEUROLOGY CLINIC AND DIAGNOSTIC CENTER PS
Entity Type:Organization
Organization Name:MOUNT RAINIER NEUROLOGY CLINIC AND DIAGNOSTIC CENTER PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KEYI
Authorized Official - Middle Name:
Authorized Official - Last Name:YANG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:253-573-0460
Mailing Address - Street 1:4426 PARADISE W AVE
Mailing Address - Street 2:
Mailing Address - City:UNIVERSITY PLACE
Mailing Address - State:WA
Mailing Address - Zip Code:98466-1024
Mailing Address - Country:US
Mailing Address - Phone:253-565-3887
Mailing Address - Fax:253-565-3887
Practice Address - Street 1:1708 SO. YAKIMA AVE
Practice Address - Street 2:STE118
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-5307
Practice Address - Country:US
Practice Address - Phone:253-573-0460
Practice Address - Fax:253-573-0461
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2015-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8863142Medicare PIN