Provider Demographics
NPI:1699253112
Name:ADVANCED INTEGRATIVE MEDICINE OF SEATTLE INSTITUTE, PLLC
Entity type:Organization
Organization Name:ADVANCED INTEGRATIVE MEDICINE OF SEATTLE INSTITUTE, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MBR
Authorized Official - Prefix:
Authorized Official - First Name:SUNIL
Authorized Official - Middle Name:K
Authorized Official - Last Name:AGGARWAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:206-420-1321
Mailing Address - Street 1:2825 EASTLAKE AVE E STE 115
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98102-3084
Mailing Address - Country:US
Mailing Address - Phone:206-420-1321
Mailing Address - Fax:833-584-0067
Practice Address - Street 1:2825 EASTLAKE AVE E STE 115
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98102-3084
Practice Address - Country:US
Practice Address - Phone:206-795-0697
Practice Address - Fax:844-668-4622
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-06
Last Update Date:2020-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2105521Medicaid