1528603503 NPI number — ELLEN POLSKY DDS AND BOBBY VIRK DMD, PS

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528603503 NPI number — ELLEN POLSKY DDS AND BOBBY VIRK DMD, PS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ELLEN POLSKY DDS AND BOBBY VIRK DMD, PS
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:
1528603503
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/13/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9317 113TH ST E STE A
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PUYALLUP
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98373-3876
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
253-848-7000
Provider Business Mailing Address Fax Number:
253-446-6138

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
34704 11TH PL S STE 101
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FEDERAL WAY
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98003-8730
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-946-5322
Provider Business Practice Location Address Fax Number:
253-446-6138
Provider Enumeration Date:
11/13/2019

Additional Information

Authorized Official

Authorized Official Last Name:
YORK
Authorized Official First Name:
XENIA
Authorized Official Middle Name:
I
Authorized Official Title or Position:
OPERATIONS MANAGER
Authorized Official Telephone Number:
253-848-7000

Provider Taxonomy Codes

  • Taxonomy code: 1223P0221X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com