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Organization
LAKE WILDERNESS MEDICAL CLINIC LLC
Active
Organization
LAKE WILDERNESS MEDICAL CLINIC LLC
Active
Other names
Chet Jangala, MD
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHESTER EDMOND JANGALA JR. MD (PHYSICIAN)
(425) 432-9611
Entity
Organization
Contact information
Practice address
26907 MAPLE VALLEY BLACK DIAMOND RD SE, MAPLE VALLEY, WA 98038-8314
(425) 432-9611
(206) 973-5399
Mailing address
PO BOX 1142, RAVENSDALE, WA 98051-1142
(425) 432-9611
(206) 973-5399
Taxonomy
Speciality
Code
Description
License number
State
261QM2500X
Medical Specialty Clinic/Center
Primary
602777613
WA
Other
Enumeration date
04/25/2008
Last updated
04/25/2008
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