Individual
KHAC LE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
16315 NE 87TH ST STE B6, REDMOND, WA 98052-3537
(425) 882-1697
Mailing address
1815 S KENT DES MOINES RD, APT A1, DES MOINES, WA 98198-2406
(404) 861-9882
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
4301110252
MI
207Q00000X
Family Medicine Physician
72098-20
WI
207Q00000X
Family Medicine Physician
MD198278
OR
207Q00000X
Family Medicine Physician
Primary
MD61056226
WA
Other
Enumeration date
06/24/2016
Last updated
10/01/2020
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