104th Avenue Medical Clinic Incorporated
NPI 1396921326 · Clinic/Center · Kent, WA
Enrolled with Medicare as Part B Supplier - Clinic/Group Practice · source: CMS PECOS Public Provider Enrollment (2026.04.01)
104th Avenue Medical Clinic Incorporated is a Clinic/Center organization in Kent, WA (NPI 1396921326).
Provider details
- NPI number
- 1396921326
- Entity type
- Organization
- Primary specialty
- Clinic/CenterAmbulatory Health Care Facilities
- Organization subpart
- No
- Authorized official
- Ranu Choudhary, Vice-President(253) 859-8371
- License
- 37861 (WA)
Specialties & taxonomies
Ambulatory Health Care Facilities
Profile Score
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
18 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
Mailing address
Registry dates
- Enumerated
- 2008-01-22
- Last updated
- 2014-10-01
Frequently asked questions
- What is 104th Avenue Medical Clinic Incorporated's NPI number?
- 104th Avenue Medical Clinic Incorporated's National Provider Identifier (NPI) is 1396921326, a unique 10-digit ID issued by CMS for use in standard healthcare transactions.
- What type of organization is 104th Avenue Medical Clinic Incorporated?
- 104th Avenue Medical Clinic Incorporated is classified in the NPPES registry as Clinic/Center (Ambulatory Health Care Facilities).
- Where is 104th Avenue Medical Clinic Incorporated located?
- 104th Avenue Medical Clinic Incorporated's practice location on file with NPPES is 24604 104th Ave Se, Kent, WA 98030-5385.
- What is 104th Avenue Medical Clinic Incorporated's phone number?
- The practice phone number listed in the NPPES registry for 104th Avenue Medical Clinic Incorporated is (253) 859-8371.
- Does 104th Avenue Medical Clinic Incorporated accept Medicare?
- 104th Avenue Medical Clinic Incorporated is approved to bill Medicare according to CMS PECOS enrollment data (2026.04.01). Confirm current participation with the provider before scheduling.
- Who is the authorized official for 104th Avenue Medical Clinic Incorporated?
- The authorized official listed on 104th Avenue Medical Clinic Incorporated's NPPES record is Ranu Choudhary, Vice-President. The authorized official registers and maintains the organization's NPI and is not necessarily its owner.
- Is 104th Avenue Medical Clinic Incorporated's NPI active?
- Yes — 104th Avenue Medical Clinic Incorporated's NPI (1396921326) is active in the NPPES registry as of the last update on 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.