Provider Demographics
NPI:1386919686
Name:WENGER, DAVID SAMUEL
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:SAMUEL
Last Name:WENGER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12303 NE 130TH LN STE 550
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-3041
Mailing Address - Country:US
Mailing Address - Phone:425-899-6972
Mailing Address - Fax:425-899-6970
Practice Address - Street 1:12303 NE 130TH LN STE 550
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-3041
Practice Address - Country:US
Practice Address - Phone:425-899-6972
Practice Address - Fax:425-899-6970
Is Sole Proprietor?:No
Enumeration Date:2012-03-20
Last Update Date:2020-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAML 60285219207R00000X
390200000X
WAMD.MD.60481954207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program