Provider Demographics
NPI:1659582385
Name:SOUTHWEST PEDIATRICS
Entity Type:Organization
Organization Name:SOUTHWEST PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:H
Authorized Official - Last Name:DONG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:206-243-4811
Mailing Address - Street 1:14212 AMBAUM BLVD SW
Mailing Address - Street 2:#202
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98166-1437
Mailing Address - Country:US
Mailing Address - Phone:206-243-4811
Mailing Address - Fax:206-243-2822
Practice Address - Street 1:14212 AMBAUM BLVD SW
Practice Address - Street 2:SOUTHWEST PEDIATRICS #202
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98166-1437
Practice Address - Country:US
Practice Address - Phone:206-243-4811
Practice Address - Fax:206-243-2822
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty