1023101706 NPI number — SELECT ORTHOPEDICS, LLC.

Table of content: SOLEDAD WANG D.O. (NPI 1205851235)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023101706 NPI number — SELECT ORTHOPEDICS, LLC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SELECT ORTHOPEDICS, LLC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1023101706
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/10/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
23632 HWY 99
Provider Second Line Business Mailing Address:
SUITE #F-453
Provider Business Mailing Address City Name:
EDMONDS
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98026
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-213-8564
Provider Business Mailing Address Fax Number:
425-670-1754

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
19217 36TH AVE W
Provider Second Line Business Practice Location Address:
SUITE #100
Provider Business Practice Location Address City Name:
LYNNWOOD
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98036-5751
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-744-5646
Provider Business Practice Location Address Fax Number:
425-670-1754
Provider Enumeration Date:
10/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SMITH
Authorized Official First Name:
STEVEN
Authorized Official Middle Name:
R
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
206-919-2277

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  602006428 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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