104th Avenue Medical Clinic Incorporated
NPI 1396921326ActiveOrganization· Clinic/Center· Kent, WA
Clinic/Center in Kent, Washington, registered in NPPES in January 2008. The authorized official on file is Ranu Choudhary, M.D., Vice-President. Enrolled in Medicare as part b supplier - clinic/group practice.
Overview
| NPI | 1396921326 |
|---|---|
| Status | Active |
| Entity type | Organization |
| NPI issued | Jan 22, 2008 |
| Last updated in NPPES | Oct 1, 2014 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Clinic/Center Primary | 261Q00000X | 37861 | WA |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Nov 10, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 11, 2026 | No match | — |
| New York OMIG · Nov 11, 2026 | No match | — |
| Ohio Medicaid · Nov 11, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 11, 2026 | No match | — |
| Washington HCA · Nov 11, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Enrolled Part B Supplier - Clinic/Group Practice (WA) |
|---|
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