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JACKSON MEDICAL CLINIC, LLC

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Company Details

Legal Name: JACKSON MEDICAL CLINIC, LLC
Jurisdiction: WASHINGTON
Entity Type: WA LIMITED LIABILITY COMPANY
Category: DOMESTIC ENTITY
Status: Administratively Dissolved
Formation/ Registration Date: March 6th 2015
Date of Dissolution: August 4th 2016
Expiration date: 31 Mar 2016
UBI Number: 603 484 733
ZIP code: 98144
City: Seattle
County: KING
Home State: WASHINGTON
Principal Office Street Address: Google Maps Logo 1200 S JACKSON ST #27, SEATTLE, WA, 98144, UNITED STATES

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Registered Agent Information

Name Role Address
TU SAM Registered Agent 1400 S JACKSON ST #3, SEATTLE, WA, 98144-0000, UNITED STATES

Key Officers & Management

Name Role Address
DAVID PHAM Governing Person 1200 S JACKSON ST #27, SEATTLE, WA, 98144, UNITED STATES
LAN LUU Governing Person 1200 S JACKSON ST #27, SEATTLE, WA, 98144, UNITED STATES

National Provider Identifier

NPI Number:
1144680240

Authorized Person:

Name:
DAVID PHAM
Role:
MD
Phone:

Taxonomy:

Selected Taxonomy:
207Q00000X - Family Medicine Physician
Is Primary:
Yes

Contacts:

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