OrganizationActive
Lake Wilderness Medical Clinic LLC
NPI 1669647152 · Medical Specialty Clinic/Center · Maple Valley, WA
Provider details
- NPI number
- 1669647152
- Entity type
- Organization
- Primary specialty
- Medical Specialty Clinic/CenterAmbulatory Health Care Facilities
- Authorized official
- Chester Jangala, Physician
- License
- 602777613 (WA)
Practice location
26907 Maple Valley Black Diamond Rd Se
Maple Valley, WA 98038-8314
Phone: (425) 432-9611
Fax: (206) 973-5399
Mailing address
Po Box 1142
Ravensdale, WA 98051-1142
Registry dates
- Enumerated
- 2008-04-25
- Last updated
- 2008-04-25
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.