Basic Information
| Provider Information | |||||||||
| NPI: | 1497787196 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HO | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | P | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3925 159TH AVE NE | ||||||||
| Address2: | LIVING WELL HEALTH CENTER | ||||||||
| City: | REDMOND | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980526309 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4252160550 | ||||||||
| FaxNumber: | 4252160551 | ||||||||
| Practice Location | |||||||||
| Address1: | 3925 159TH AVE NE | ||||||||
| Address2: | LIVING WELL HEALTH CENTER | ||||||||
| City: | REDMOND | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980526309 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4252160550 | ||||||||
| FaxNumber: | 4252160551 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/06/2006 | ||||||||
| LastUpdateDate: | 03/18/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | MD00028005 | WA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 8145112 | 05 | WA | MEDICAID |