Provider Demographics
NPI:1194327221
Name:PUGET SOUND PLASTIC SURGICAL GROUP, PLLC
Entity type:Organization
Organization Name:PUGET SOUND PLASTIC SURGICAL GROUP, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ARTHUR
Authorized Official - Middle Name:H
Authorized Official - Last Name:GEE
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:425-420-2663
Mailing Address - Street 1:PO BOX 723
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98083-0723
Mailing Address - Country:US
Mailing Address - Phone:425-420-2663
Mailing Address - Fax:425-409-6262
Practice Address - Street 1:12301 NE 10TH PL STE 101
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005-2487
Practice Address - Country:US
Practice Address - Phone:425-420-2663
Practice Address - Fax:425-409-6262
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-13
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty