BRIDGEPORT MEDICAL CLINIC PLLC (NPI# 1982855995) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1982855995 |
| Entity Type | Organization |
| Organization Name | BRIDGEPORT MEDICAL CLINIC PLLC |
| Practice Address |
11306 Bridgeport Way Sw Suite B Lakewood WA 98499-3037 |
| Practice Telephone | 2535880370 |
| Practice Fax Number | 2535884986 |
| Mailing Telephone | 2535880370 |
| Mailing Fax Number | 2535884986 |
| Enumeration Date | 2008-10-08 |
| Last Update Date | 2008-10-08 |
| Authorized Official Name | DR. DENNIS JOOYOUNG KIM (MEMBER) |
| Authorized Official Telephone | 2535880370 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261Q00000X | Clinic/Center | MD00041157 | WA | Ambulatory Health Care Facilities |
| Street Address |
11306 BRIDGEPORT WAY SW SUITE B |
| City | LAKEWOOD |
| State | WA |
| Zip Code | 98499-3037 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124009303 | Kyong Ho Kim | Pain Medicine | 11306 Bridgeport Way Sw, Suite D, Lakewood, WA 98499-3037 | 2005-11-07 |
| 1013311679 | Paul Bradley | Physician Assistant | 11306 Bridgeport Way Sw, Ste D, Lakewood, WA 98499-3037 | 2014-10-10 |
| 1053431684 | Sound Pain Alliance | Pain Medicine | 11306 Bridgeport Way Sw, #d, Lakewood, WA 98499-3037 | 2007-03-29 |
| 1215023940 | Lakewood Surgical Urology Ps | Urology | 11306 Bridgeport Way Sw, Suite D, Lakewood, WA 98499-3005 | 2006-10-04 |
| 1669586087 | Dennis Jooyoung Kim | Internal Medicine | 11306 Bridgeport Way Sw, Suite B, Lakewood, WA 98499-3037 | 2006-08-19 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1275159592 | Sea Mar Community Health Centers | Clinic/Center | 5700 100th Street Se, Suite 510, Lakewood, WA 98499 | 2020-06-23 |
| 1568018828 | Heather Leigh Andrade | Behavioral Analyst | 6210 75th St W Ste 100, Lakewood, WA 98499 | 2019-08-13 |
| 1043870876 | Seoul Chinese Herbs Inc | Acupuncturist | 8705 S. Tacoma Way, Lakewood, WA 98499 | 2019-06-14 |
| 1013572064 | Puget Sound Kidney Centers | Clinic/Center | 11950 47th Ave Sw, Lakewood, WA 98499 | 2019-05-06 |
| 1447736657 | Marcela Cunan | Counselor | 9330 59th Avenue Southest, Lakewood, WA 98499 | 2018-07-11 |
| 1609382381 | Leroy Moore IIi | Counselor | 8811 S. Tacoma Way, 106, Lakewood, WA 98499 | 2017-12-18 |
| 1578077657 | Andrea Gaston | Behavior Technician | 8815 S. Tacoma Way, Suite 122, Lakewood, WA 98499 | 2017-11-27 |
| 1609389931 | Jennifer King | Social Worker | 5900 100th St Sw Ste 17b, Lakewood, WA 98499 | 2017-11-08 |
| 1750806337 | Wonyoung Lee | Counselor | 8811 South Tacoma Way, Suite 106, Lakewood, WA 98499 | 2017-08-04 |
| 1043749443 | Frederick Paltron Edwards | Counselor | 9500 Front Street, Suite 100, Lakewood, WA 98499 | 2017-06-08 |
| Find all providers in zip 98499 | ||||
| Taxonomy Code | 261Q00000X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| A facility or distinct part of one used for the diagnosis and treatment of outpatients. "Clinic/Center" is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health). |
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| 1295997153 | Ace Counseling LLC | Clinic/Center | 959 S Saulsbury St, Lakewood, CO 80226-4513 | 2008-07-01 |
| 1265654958 | Avalon Clinic | Clinic/Center | 6103 Mount Tacoma Dr Sw, Lakewood, WA 98499-2727 | 2007-05-03 |
| 1952526675 | South Cerritos Medical Group, Inc. | Clinic/Center | 20927 Norwalk Blvd, Lakewood, CA 90715-1545 | 2007-04-16 |
| 1568002137 | Cleveland Performance Chiropractic, LLC | Clinic/Center | 15713 Detroit Ave, Lakewood, OH 44107-3709 | 2020-01-13 |
| 1699271221 | Sound Body Chiropractic and Wellness LLC | Clinic/Center | 12792 W Alameda Pkwy Ste E, Lakewood, CO 80228-2846 | 2018-04-03 |
| 1699276980 | Rocky Mountain Youth Medical and Nursing Consultants, Inc | Clinic/Center | 355 Union Blvd, 100, Lakewood, CO 80228-1500 | 2018-02-22 |
| Find all providers in LAKEWOOD | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.