Individual
OLEG E GORDIENKO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
34509 9TH AVE SO, SUITE #308, FEDERAL WAY, WA 98003-8710
(253) 874-4352
(253) 874-5537
Mailing address
34509 9TH AVE SO, SUITE #308, FEDERAL WAY, WA 98003-8710
(253) 874-4352
(253) 874-5537
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD00023693
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1039320
—
WA
01
—
208194
PHCS
MA
01
—
35595
L & I
WA
01
—
4078430
AETNA
WA
Enumeration date
10/25/2006
Last updated
07/08/2007
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