Provider Demographics
NPI:1306055926
Name:SEATTLE NEPHROLOGY PLLC
Entity type:Organization
Organization Name:SEATTLE NEPHROLOGY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JUNG
Authorized Official - Middle Name:H
Authorized Official - Last Name:JOH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:206-542-1000
Mailing Address - Street 1:1130 N 185TH ST STE 201
Mailing Address - Street 2:
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98133-4011
Mailing Address - Country:US
Mailing Address - Phone:206-542-1000
Mailing Address - Fax:206-542-5353
Practice Address - Street 1:1130 N 185TH ST STE 201
Practice Address - Street 2:
Practice Address - City:SHORELINE
Practice Address - State:WA
Practice Address - Zip Code:98133-4011
Practice Address - Country:US
Practice Address - Phone:206-542-1000
Practice Address - Fax:206-542-5353
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1202SEOtherREGENCE BLUE SHIELD
WACJ4503OtherRAILROAD MEDICARE
WA7111693Medicaid
WACJ4503OtherRAILROAD MEDICARE
WA7111693Medicaid
WAI12794Medicare UPIN
WAGAB25199Medicare PIN