Great Wall Clinic

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

License

DE00007365 Issued in WA

Legal business name

GREAT WALL CLINIC

Practice address

18230 E Valley Hwy
168
Kent, WA 98032-1259

Phone

(425) 656-9025

NPI assigned

Dec 3, 2009

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ephraim Rollolazo

Title

Office Manager

Phone

(425) 656-9025

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1259798400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1259798400000",
    "number": "1184952079",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18230 E VALLEY HWY",
            "address_2": "168",
            "city": "KENT",
            "state": "WA",
            "postal_code": "980321259"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18230 E VALLEY HWY",
            "address_2": "168",
            "city": "KENT",
            "state": "WA",
            "postal_code": "980321259",
            "telephone_number": "425-656-9025"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREAT WALL CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-12-03",
        "last_updated": "2009-12-03",
        "status": "A",
        "authorized_official_last_name": "ROLLOLAZO",
        "authorized_official_first_name": "EPHRAIM",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "425-656-9025"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "WA",
            "license": "DE00007365",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DSHS PROVIDER NUMBER",
            "identifier": "5034616",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jennifer Marie Gray, RPH
• Sheldon Gray
• Tiffany Ann Gray
• Timothy Ross Gray, DDS
• Tracy Gray, LMT, GCFP
• Greater Heights Afh Corp
• Green Valley Afh #2 LLC
• Angela Green
• Cassandra Louise Green, LMP
• Kady Falon Green, DPT

• Dental Clinic/Center in Kent, WA
• Providers in Kent, WA by specialty
• Dental Clinic/Center in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.