Mod Skin and Body Clinic

Primary specialty

SpecialistTaxonomy code 174400000X

Legal business name

MOD SKIN AND BODY CLINIC

Practice address

14130 Juanita Dr NE Ste 110
Kirkland, WA 98034-0127

Phone

(425) 406-8455

NPI assigned

Dec 9, 2013

Organization subpart

No

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

Authorized official

Name

Polly Tabares

Title

Ceo

Phone

(425) 406-8455

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1386547200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1389312000000",
    "number": "1801227327",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14130 JUANITA DR NE STE 110",
            "city": "KIRKLAND",
            "state": "WA",
            "postal_code": "980340127",
            "telephone_number": "425-406-8455"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14130 JUANITA DR NE STE 110",
            "city": "KIRKLAND",
            "state": "WA",
            "postal_code": "980340127",
            "telephone_number": "425-406-8455"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOD SKIN AND BODY CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-12-09",
        "last_updated": "2014-01-10",
        "status": "A",
        "authorized_official_last_name": "TABARES",
        "authorized_official_first_name": "POLLY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "425-406-8455"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Specialist in Kirkland, WA
• Providers in Kirkland, WA by specialty
• Specialist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 10, 2014; 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.