OrganizationActive
104th Avenue Medical Clinic Incorporated
NPI 1396921326 · Clinic/Center · Kent, WA
Provider details
- NPI number
- 1396921326
- Entity type
- Organization
- Primary specialty
- Clinic/CenterAmbulatory Health Care Facilities
- Authorized official
- Ranu Choudhary, Vice-President
- License
- 37861 (WA)
Practice location
24604 104th Ave Se
# 202
Kent, WA 98030-5385
Phone: (253) 859-8371
Fax: (253) 859-9593
Mailing address
24604 104th Ave Se
Kent, WA 98030-5385
Registry dates
- Enumerated
- 2008-01-22
- Last updated
- 2014-10-01
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.