Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

104th Avenue Medical Clinic Incorporated

Organization Clinic/Center · NPI 1396921326

104th Avenue Medical Clinic Incorporated is a Clinic/Center in Kent, Washington. Licensed in Washington. Registered with an NPI since 2008.

Licensed in
WA
In the registry since
2008

Practice location Address checks out

24604 104th Ave SE # 202
Kent, WA 98030-5385
Phone: (253) 859-8371
Fax: (253) 859-9593
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Clinic/Center (primary) Taxonomy 261Q00000X · Licence 37861 (WA)

Record details

NPI number1396921326
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Ranu Choudhary — Vice-President · (253) 859-8371
NPI enumeratedJanuary 22, 2008
Last updated in NPPESOctober 1, 2014
Mailing address24604 104th Ave Se, 202, Kent, WA 98030-5385

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