Lake Wilderness Medical Clinic LLC

Primary specialty

Medical Specialty Clinic/CenterTaxonomy code 261QM2500X

License

602777613 Issued in WA

Legal business name

LAKE WILDERNESS MEDICAL CLINIC LLC

Practice address

26907 Maple Valley Black Diamond Rd SE
Maple Valley, WA 98038-8314

Phone

(425) 432-9611

Fax

(206) 973-5399

NPI assigned

Apr 25, 2008

Organization subpart

No

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

Authorized official

Name

Dr. Chester Edmond Jangala Jr., MDNPI 1538115472

Title

Physician

Phone

(425) 432-9611

Specialties & licenses 1

Addresses

Other names 1

• Chet Jangala, MD Doing business as

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Chester Edmond Jangala, MD

  • Family Medicine Physician
  • Maple Valley, WA
  • NPI 1538115472
  NPD (past) Authorized official

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

{
    "created_epoch": "1209081600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1209081600000",
    "number": "1669647152",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1142",
            "city": "RAVENSDALE",
            "state": "WA",
            "postal_code": "980511142",
            "telephone_number": "425-432-9611",
            "fax_number": "206-973-5399"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "26907 MAPLE VALLEY BLACK DIAMOND RD SE",
            "city": "MAPLE VALLEY",
            "state": "WA",
            "postal_code": "980388314",
            "telephone_number": "425-432-9611",
            "fax_number": "206-973-5399"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE WILDERNESS MEDICAL CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-25",
        "last_updated": "2008-04-25",
        "status": "A",
        "authorized_official_last_name": "JANGALA",
        "authorized_official_first_name": "CHESTER",
        "authorized_official_middle_name": "EDMOND",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "425-432-9611",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": "WA",
            "license": "602777613",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Chet Jangala, MD",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Eddie Mugo Kuira
• Elvina Kuzmich, MS
• L Carlos Morales DDS PS
• Tanya Marie Labrador
• Victoria Labrie, ATC
• Lake Wilderness Medical Clinic LLC
• Bronston Stuart Lallier, PHARMD
• Jessica Lancaster, DO
• Alyssa N Laney
• Sandy Larios

• Medical Specialty Clinic/Center in Maple Valley, WA
• Providers in Maple Valley, WA by specialty
• Medical Specialty Clinic/Center in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 25, 2008; 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.