Organization
PA SURGICAL SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KENT WALLACE PA-C (OWNER)
(425) 899-5510
Entity
Organization
Contact information
Practice address
12303 NE 130TH LN, SUITE 520, KIRKLAND, WA 98034-3099
(425) 899-5510
(425) 899-5524
Mailing address
PO BOX 8592, KIRKLAND, WA 98034-0592
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
PA10000442
WA
Other
Enumeration date
11/02/2006
Last updated
08/22/2020
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