Provider Demographics
NPI:1497827711
Name:SAMUEL K. SETO MD PLLC
Entity Type:Organization
Organization Name:SAMUEL K. SETO MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:K
Authorized Official - Last Name:SETO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:425-774-7723
Mailing Address - Street 1:21911 76TH AVE W
Mailing Address - Street 2:SUITE 101
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98026-7903
Mailing Address - Country:US
Mailing Address - Phone:425-774-7723
Mailing Address - Fax:425-778-2788
Practice Address - Street 1:21911 76TH AVE W
Practice Address - Street 2:SUITE 101
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026-7903
Practice Address - Country:US
Practice Address - Phone:425-774-7723
Practice Address - Fax:425-778-2788
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00032689174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0151324OtherLABOR AND INDUSTRIES
WA7701204Medicaid
WA7701204Medicaid
WA1185200001Medicare NSC