Provider Demographics
NPI:1689116691
Name:PEDIATRIC HEALTH CARE
Entity Type:Organization
Organization Name:PEDIATRIC HEALTH CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:F.A.A.P.
Authorized Official - Prefix:
Authorized Official - First Name:MAZEN
Authorized Official - Middle Name:
Authorized Official - Last Name:DAHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:253-848-7660
Mailing Address - Street 1:1420 3RD ST SE
Mailing Address - Street 2:STE. 200
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98372-3730
Mailing Address - Country:US
Mailing Address - Phone:253-848-7660
Mailing Address - Fax:253-841-1801
Practice Address - Street 1:1420 3RD ST SE
Practice Address - Street 2:STE. 200
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98372-3730
Practice Address - Country:US
Practice Address - Phone:253-848-7660
Practice Address - Fax:253-841-1801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-08
Last Update Date:2016-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60705836363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatricsGroup - Single Specialty