Provider Demographics
NPI:1487669305
Name:EAR NOSE AND THROAT ASSOCIATES SOUTHWEST INC PS
Entity type:Organization
Organization Name:EAR NOSE AND THROAT ASSOCIATES SOUTHWEST INC PS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SUNG-WON
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:360-357-6314
Mailing Address - Street 1:128 LILLY RD NE STE 202
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98506-5029
Mailing Address - Country:US
Mailing Address - Phone:360-357-6314
Mailing Address - Fax:360-705-3745
Practice Address - Street 1:128 LILLY RD NE STE 101
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506-7400
Practice Address - Country:US
Practice Address - Phone:360-634-4070
Practice Address - Fax:360-634-4071
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-29
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory SurgicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAGAB00823Medicare PIN
WAAB00823Medicare UPIN