Provider Demographics
NPI:1215120241
Name:VAN DEN BOSCH, JOHN FRANCIS JR (LMP)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:FRANCIS
Last Name:VAN DEN BOSCH
Suffix:JR
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 SW 150TH ST
Mailing Address - Street 2:SUITE # 218
Mailing Address - City:BURIEN
Mailing Address - State:WA
Mailing Address - Zip Code:98166-1855
Mailing Address - Country:US
Mailing Address - Phone:206-241-4699
Mailing Address - Fax:206-242-0328
Practice Address - Street 1:801 SW 150TH ST
Practice Address - Street 2:SUITE # 218
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98166-1855
Practice Address - Country:US
Practice Address - Phone:206-241-4699
Practice Address - Fax:206-242-0328
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-22
Last Update Date:2007-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00006756174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist